Strategies for Reducjng 


Chronic Street H-omelessness 


Final Report 

Prepared for: 


u.s. Department of Housing and Urban Development 


Office of Policy Development and Research 


Prepared by: 


Martha R. Burt, U I 


John Hedderson, WRMA 


Janine Zweig, UI 


Mary Jo Ortiz, WRMA 


Laudan Aron-Turnham, UI 


Sabrina M. Johnson, WRMA 


Walter R. McDonald & Associates, Inc. (WRMA) 


Sacramento, CA 


The Urban Institute (UI) 


Washington, DC 


January 2004 
ACKNOWLEDGEMENTS 

Many individuals have assisted us on this project; we would especially like to thank the 

following: 

• 	 The researchers and program administrators who nominated potential sites. 

• 	 The on-site people we interviewed individually, in meetings and in focus groups who 

shared their time, information, and insights with us. 

• 	 Our advisory team members, Donald J. Baumann, Deborah Dennis, Linda Gibbs, 

Jean L. Hochron, Mark Hurwitz, Natalie Hutcheson, Pam Michell, Pat Morgan, Ann 

O'Rielly, and Robert A. Rosenbeck, who have contributed their time, knowledge, and 

expertise. 

• 	 Marina Myhre, our project Government Technical Representative from the U.S. 

Department of Housing and Urban Development (HUD), who has provided us with 

helpful support, observations and thoughts throughout the study. Other BUD staff 

members who have also provided acute comments on the projects research design, 

data analysis and report include Paul Dornan, Marge Martin, and Kevin Neary from 

the Office of Policy Development and Research, and Mark Jolmston from the Office 

of Community Planning and Development. 

In addition, we would like to acknowledge the work completed by the following Walter R. 

McDonald & Associates, Inc. staff: Deborah Bass Rubenstein was fully involved in the early 

stages of this project, especially the research design and screening of sites; Charles Wheeler 

assisted in the report review; Gayleen Lentsch was in charge of report production; Cheryl Reed 

coordinated travel arrangements; Maricela Leyva-Perez and Jamie Yang provided administrative 

support. 

We appreciate the significant contributions that the above individuals made to carrying out the 

research and writing of this report, and they are not responsible for any remaining errors or 

omissions. The findings and views herein are those of the contractors and authors. 

The contents of this report are the views of the contractor and do not necessarily reflect the views 

or policies of the U.S. Department of Housing and Urban Development or the U.S. Government. 
TABLE OF CONTENTS 


ACKNOWLEDGElVlENTS ........................................................................................................ II 


EXECUTIVE SUMMARY ..................................................................................................... XllI 


Why This Study Is Important. .......... _ ..................................... ................................... .............. ... .. xiii 


New Strategies for Programs and Services ..................................... .............................................. xx 


Documenting Progress .............. ............ ...................................................................................... xxii 


How Do They Pay For It? .................................................. ........................................................ xxiii 


Implications ........................... ..................................................................................................... xxiv 


Implications for Policy ............................................................................... ............................ xxiv 


Implications for Practice ........................................................................................................ xxvi 


Implications for Research ..................................................................................................... xxvii 


Purpose of the Research ............................................................................................................... xiv 


Who, What, Where, and When? .................................. .. ............................................................... xv 


Findings-Key Elements of Success .. ... ....................................................................................... xv 


How They Got Where They Are Today-Key Factors in History and Implementation ............ xvii 


Trigger Events and Paradigm Shifts ....................................................................................... xvii 


Thoughtful, Analytic Process ................................................................................................... xix 


CHAPTER 1: INTRODUCTION................................................................................................ 1 


Why This Study Is Important.. ........................................................................................................ 1 


Purpose of the Research .......... ..................................... _ .................................................................. 2 


Who, What, Where, and When ....................... .. .............................................................. ................ 3 


Birmingham, Alabama ................................................................................................................ 4 


Boston, Massachusetts ................................................................................................................ 5 


Columbus, Ohio .......................................................................................................................... 5 


Los Angeles, California ........................ ... ................................... ..... ........................................... 6 


Philadelphia, Pennsylvania ... ....... '" ............................................................................................ 6 


San Diego, California .................................................................................................................. 7 


Seattle, Washington .................................................................................................................... 7 


Report Organization ........................................................................................................................ 8 


CHAPTER 2: ELElVlENTS OF SUCCESS................................................................................ 9 


What Does It Take? ........................................................................................................................ 9 


Introduction......................................................... .. .......... ............. .. ... .............................................. 9 


Paradigm Shift ................................................................... .......................................................... . 10 


A Clear Goal of Ending Chronic Street Homelessness ................................................................ 10 


Strong Community-Wide Level of Organization ......................................................................... 11 


Strong Leadership and an Effective Organizational Structure .............. ...................... ................. 12 


The Importance of Key People Exercising Leadership ............................................................ 12 


Effective Organizational Structure ....................................................... .................................... 12 


Significant Resources from Mainstream Public Agencies ................................................. ........... 13 


Ability to Capitalize on Trigger Events ........ ................................................................................ 13 


III 
Table of Contents 

Significant Involvement of the Private Sector.. ..... .... ........ .. .. .......... ................. ............................ 14 


Private Businesses ..... ............................ ..... ............ ................ .. ............... ......... ........ .. ........... .... 14 


Foundations and Nonprofit Organizations .... .. ...... ..................................... .............. ........... ...... 15 


Commitment and Support from Elected Officials ......... .......... .. ..................... .. .. .......................... 15 


Outcome Evaluation Mechanisms for Program Support and Improvement.. ............................... 16 


Openness to New Service Approaches ................... .......................... .. .......................................... 16 


Strategies to Minimize Negative Neighborhood Reactions to Locating Projects .................. .. ... .. 17 


Conclusions .. .......... _............... .................. .. ........................ ................................................... ....... 17 


CHAPTER 3: NEW STRATEGIES FOR PROGRAMS AND SERVICES ......................... 19 


Outreach ... .... .... ........................ ..................................................................................... .. ........... ... 20 


Philadelphia's Outreach Coordination Center .......................................................................... 20 


San Diego's Police·Based Outreach Teams ................... ...................... ........................... .. ....... 21 


Other Outreach Efforts with Direct Housing Connections .... ......... .... .. ....................... ............. 22 


Other Outreach Efforts Without Direct Housing Connections ............. ............ .................... .... 23 


New Approaches to Permanent Supportive Housing (PSH) ... ...................................................... 23 


Housing First Models .. ........ .. ............................ ........................................................................ 25 


Safe Havens ........ ...... .. ............................ ........... ........................ .......... .. .. ............................... .. 25 


Low Demand-Breaking the Linkage Between Housing and Service Acceptance ................. 26 


New Approaches to Addressing Substance Abuse ..... ................................................ .. ................ 26 


Harm Reduction .. .. .................................... ............. ............................................ ........ ............... 27 


Other Approaches ......... ............................ .. .. ....... .. .................... ..... ................... ............. ........ .. 28 


Housing Configurations and Supportive Services ............................ .. ........................... ............. .. 29 


Preventing Homelessness Upon Institutional Discharge .............................. ........................... ..... 31 


Client-Level Coordination Mechanisms ..... .. ................................. ............. .................................. 32 


Databases ... .... ................................. .. ............ ....................................................... ..................... 32 


Multi-Agency Special Case Teams ............. ................. .. ................. .......... .. .. ... .................... .. ... 34 


Multi-Purpose Service Centers ....................................... .......... ................ ........ .. .. .................... 34 


Processes to Alter Access to Mainstream Settings .. .............. .............................................. ......... 36 


Co-location of Service Providers in Mainstream Agencies .......... ............... .. ........................... 36 


New Roles in Old Agencies .. ...................... ...... ........... ....... .. .......... ... ... .............................. ...... 37 


Conclusions ............. ..... ..... .. ......................... .. ............. ........................................................ .......... 38 


CHAPTER 4: ASSEMBLING RESOURCES AND SUPPORTS .......................................... 41 


Assembling Resources in Communities with Long Histories of Support .............. ...................... 41 


Philadelphia................................... ................... .......... .... .................................. ......................... 41 


Columbus ............................................................ .... .......................... .. ..... ............... .. ... ....... ...... 43 


Mobilizing Resources "From Scratch" ........ .......... ............................................. .................... .... .. 44 


San Diego .................................................. ............................... .. .. ............. .......................... .. ... . 45 


Los Angeles Veterans Affairs ............... ............. .............. ......... ..... .. ................... ...... .... .. ....... ... 47 


Progress Without Community-Level Commitment to Ending Chronic Homelessness ............ .... 48 


Seattle Program Structure Growing Out of ACCESS.. ..................................................... .. .. .... 48 


Conclusions ..... .. .. .. .... ......... ... ....... .... .... ........ ........... ....... .......... ............. .. ........... ........................... 49 


CHAPTER 5: DOCUMENTING PROGRESS ........................................................................ 51 


Changes in the Number of People Found on the Street from Year to Year.. ................. ..... .. .. ...... 51 


IV 
Table of Contents 

Philadelphia Counts of Street Homeless Persons ........................................ ............................. 52 


Birmingham Street Counts ................ ......................... .................................................. ............ . 53 


Seattle Street Counts .................. ............................. ........................................................ .......... 54 


Boston Street Counts ........... .. .................... ........... _........................... ................. ....................... 55 


Chronically Homeless Individuals Moved to Permanent Housing ............................. ............... ... 56 


Philadelphia Movement of Chronically Homeless Individuals into P.ermanent Housing ........ 56 


San Diego Mevement of Chronically Homeless Individuals into Housing ............... ............... -57 


Birmingham Movement of Chronically Homeless Individuals into Permanent Housing ........ 58 


Reductions in Costs of Providing Emergency Health, Mental Health, and Shelter Services ...... . 58 


Reductions in Days Homeless, Hospitalized, or Incarcerated ........... ..... ........... ... ........... ............ . 60 


Conclusions....................................... ..................... ............ ...................................................... .. ... 61 


CHAPTER 6: HOW COM1\1UNITIES PAY FOR THEIR NEW APPROACHES ............. 63 


Introduction................................ ............ ..... ....................... ................... ....... .................................. 63 


Local Funding ............................... ................................................................................................ 63 


General Revenue Resources ......................... .... ................ .. .............. ........................................ 64 


Special Taxing Mechanisms ............... .. .................................................................. .................. 64 


Use of Private Sector Resources ......... ................................... ............... .............................. ...... 65 


State Funding ..... ...................... ..................................................................................................... 66 


California ........... ............... ........................... ...................... ............ .. .................................... ..... 66 


Other State Funding Streams ..... .................................................................. ............................. 67 


Federal Funding Other Than McKinney ..................................................... .................................. 68 


Self Support ...... ................ ............................................................... .......... ................ .......... ......... 70 


Funds Blending and Access ...................... .............................. .. .................................................... 70 


Blending Funding from the Provider Perspective ........ ............... .............. ... ............................. 70 


Agencies As Funding Funnels to Ease Client Access to Services ......... ........................... ........ 72 


Potentially Underused Funding Opportunities .................. .............. .... ............................... ........... 74 


CHAPTER 7: POLICY, PRACTICE, AND RESEARCH IMPLICATIONS ...................... 77 


Implications for Policy .................. ...... ... ... .... ................ ............................. ... .. ... ........................... 77 


Implications for Practice .............................................. ................... ......................................... ..... 78 


Implications for Research ............................................................................................................. 79 


APPENDIX A: BIRMINGHAM ..............................................................................................A.l 


Birmingham-Brief Description .. ... ................ ............... ............................... .................. ...A .1 


Practices of Potential Interest to Other Jurisdictions ............... ...... ....... ..... ....... .. ............ . A.2 


History and Context-How the Current System Evolved .................... .................. ... .... .. .. A.3 


Approach to Chronic Street Homelessness .. .............................. ... ........ .... .. ..................... AA 


Sector of Mainstream Agencies .................................................. ...... ................... A.6 


Use of Private Resources ........................ .................................... ...... .... .. ....... ......A.6 


Coordination Mechanisms ... ....................................................... ........ ............... .. A.9 


Pathways to Housing, Approaches and Models ..................... .. .......................... A.l0 


Selected System Components ................................................ .. .. .............................. ... .. .A.10 


Program and Service Network .. ....................... .. ..................... ..... ........ .. .. .. ...... ....A .5 


Who Is Served? ............................ ............................ .......................................... .. A.7 


v 
Table of Contents 

Prevention .. ..... ....... ........................................................... ................................. A.II 


OutreachlDrop-in .................................................................................... ...........A.II 


Low Demand Transitional Residences .............................................................. A.12 


Emergency Shelters .................................... .. ... ... ........................................... .. .. A.12 


Transitional Programs .................................. .................................................. _.. A.12 


Permanent Supportive Housing .. .................. .......... .. ............. ................ .... ........ A.13 


Supportive Services ........................................................................................... A.13 


Affordable Housing ........................................................................................... A.14 


Documenting Reductions in Chronic Street Homelessness ......................... .. ................ A.14 


Street Counts .......................................... ......................................................... .. . A.14 


Movement of Street Homeless into Housing ... ...... ........ .. ....... ...... .................. ...A.I5 


Public ·Funding ............................................................................................................... A.15 


Community Relations ............................. ....................................................................... A.16 


Maintaining and Enhancing the System .................................................................. ... ... A.16 


Site Visit Participants ..................... .................................................... ............................ A.I8 


Acronyms ........ .. ....................... .. .......................... ... ....................................................... A.I9 


APPENDIX B: BOSTON .......................................................................................................... B.1 


Boston-Brief Description ................................ .. .................... ....... ................ ................... B.l 


Practices of Potential Interest to Other Jurisdictions ..... ................. ................................. B.2 


History and Context-How the Current System Evolved ................................................. B.4 


Approach to Chronic Street Homelessness ............................................................ _ ........ B.5 


Selected System Components ............... .. ..... ...... ............................................................ B.l 0 


Prevention ...... ............................... .......................... .................................... ....... B.l 0 


Outreach and Drop-in ........... ............................................................................. B.Il 


Emergency Shelters ................................. ...... .... ..................... ...... ..................... B.13 


Low-Demand Residences ......... ................... ...................................................... B.13 


Transitional Programs .......................... ..................... ....... ................ .................. B.13 


Permanent Supportive Housing .................................. ....................................... B.14 


Supportive Services ............................... .............. .............................................. B.I5 


Affordable Housing .. ....................................... ................. ......................... ........ B.15 


Documenting Reductions to Chronic Homelessness ..................................................... B.16 


Public Funding .................................... ........................................................................... B.17 


Community Relations and Advocacy ............................................................................ B.19 


The Future-Maintaining and Enhancing the System ..................................................... B.19 


Site Visit Participants .......................................... ...... .. ........................ ........................... B.20 


Acronyms .......... ................................ ................................................. ............................ B.22 


Mainstream Agency Involvement. ... ......................................... .............................. ......... B.7 


APPENDIX C: COLUMBUS....................................................................................................C.1 


Brief Description .............................................................................................................. C.I 


Practices or Potential Interest to Other Jurisdictions ............ .. .. ....................................... C.2 


History and Context-How the Current System Evolved ............................................ ..... C.3 


Approach to Chronic Street Homelessness ............. ..... .................................................... C.5 


Selected System Components ............. ........................ .. ................................................. C.I 0 


Mainstream Involvement ................................................................................................. C. 7 


VI 
Table of Contents 

Prevention .................. ................................. .. ...... .. ............................................. C.l 0 


Outreach and Drop-in .. ...................................................................................... C.ll 


Emergency Shelters ...... ................... .... .. ...... ............ ........ .................................. C.ll 


Transitional Programs .. .. ................ ........ ........................................... ................. C.12 


Permanent and Supportive Housing ................ ............. ............. ... .. ... ... ......... ..... C.12 


Supportive Services ............... .......................... .......... .. ................... ................... C.16 


Affordable Housing ...... .......................... ........................... .............. ............ ... ... C.16 


Documenting Reduc tions in Chronic Street Homelessness ....... ............................ ........ C.17 


Public Funding ......... ...................................................................................................... C.19 


Community Relations and Advocacy .......................... ................................................. . C.23 


Elements of Good Neighbor agreements ........................................................... C.24 


The Future-Maintaining and Enhancing the System ........... ..................................... .. .. .C.26 


Resource Development .............................. ........................................................ C.27 


Improving Cost Efficiency ........ .................................................................... .. ... C.27 


Collaborative Investment Standards .. ........ ........................................................ C.28 


Evaluation ...................................................... ... ....... .. ....... .. ......... ............ ..... ..... C.28 


Communication ........................... ............... ............... ... ................................. ... .. C.28 


Site Visit Participants .......... ............................ .... .............................. ........... .................. C.29 


Acronyms ........................................... .................... ......... ... .... ...................... .... .............. C.30 


APPENDIX D: LOS ANGELES .............................................................................................. D.l 


Los Angeles- Brief Description .............................. ..... .. .. ................................................. D.l 


Greater Los Angeles Department of Veterans Affairs .. ................................................... D.2 


Practices of Potential Interest to Other Jurisdictions ..... ... ......................................... ...... D.2 


V AGLAHS ...... ........ ........................ ............... .......... ........................................... D.2 


AB 2034 ... ............... ... ........................................................ ................. ................. D.2 


Lamp Community ............. ....... ... ..................................... .............................. ..... . D.3 


VAGLAHS History and Context-How the Current System Evolved ............................. D.4 


VAGLAHS Approach to Chronic Street Homelessness ............ ...................................... D.5 


VAGLAHS Selected System Components .. .................... ...... ............ .............................. D.9 


Outreach and Drop-in ................................ .................... ........................ ....... ....... D.9 


Emergency Shelters ............................... ............................................................ D.II 


Transitional Programs ....................... .............. ................................................... D.12 


Employment .. ..................................................................................................... D.17 


Case Management ........ ...................................................................................... D .17 


V AGLAHS Documenting Reductions to Chronic Street Homelessness ....................... D.19 


V AGLAHS Community Relations and Advocacy ................... ..................................... D.20 


Los Angeles County AB 2034 Program .................... .... ... .... .... ..................................... D.2l 


AB 2034-Access to the System ........................... ................................. .... ... .. ... ........... .. D.23 


AB 2034-Housing ................................ ... ....... ................. ............. ........... ...................... D.24 


AB 2034-Documenting Reductions to Chronic Street Homelessness .......................... D.25 


AD 2034-Model of Care .. .................................................................................. ........... D.26 


Program Components-San Fernando Valley Community Mental 


Health Center .... .. ....... ... .. .. ..................................... ....... ........................................... ...... D.26 


San Fernando Valley Community, Mental Health Center, Inc ......................................D.26 


Outreach ............... .............................................................................................. D.26 


Vll 
Table of Contents 

Emergency Shelters ........................................................................................... D.27 


Transitional Program ......... ............................. ............. ....... .. ................. ............ D.27 


Permanent Supportive Housing ....................................................................... .. D.27 


Supportive Services ........................................... ................... .......................... D.27 


AB 2034-Community Relations and Advocacy ...... ... ............ .. .. .......... ................ .. .. ..... D.28 


Lamp Community ....................................................................... .. ..... .... ............ ... ......... D.28 


Lamp Community History ............. .. .................... ...... ...................... .... .......................... D.28 


Lamp Community Model ........................................... _................................................... D.29 


Lamp-Community Components ............................................... ...................................... D.29 


Street Outreach ........... ... ........................ ....... ......................... ............................. D.29 


Low Demand Transitional Housing ........... .. ...... _ ......................................... ... .. D.33 


Lamp Community Housing .............................................................. .. ................ D.32 


Member-Operated Business and Other Employment Services .......................... D.34 


Supportive Services .......... ................................................... .. ... ......................... D.34 


Lamp Community-Documenting Reductions to Chronic Street 


Homelessness ......... ..................................... .......... ....................... ...................... D.35 


Lamp Community-Community Relations and Advocacy .... .. ............... .. ...................... D.36 


Site Visit Participants ..................................................................................................... D.37 


Acronyms ...... ............. .. .. .. ............. ...... ... ... .. .. ... .................................. ............ ... ... .......... D.40 


APPENDIX E: PHILADELPHIA ............................................................................................ E.l 


Philadelphia-Brief Description ........................................................ _ ............................. . E.1 


Practices of Potential Interest to Other Jurisdictions .......... .. ........................................... E.2 


History and Context-How the Current System Evolved .................................... ...... ....... E.3 


Mayoral Support and Public Leadership .............................................................. E.4 


Demonstration Program Participation .................................. _ ..... ......................... E.6 


Turning Points and the Role ofAdvocacy-No Movement 


Without Tension .................. .. ........... ... ..................... ... ....... .. .................... ..... ... E.7 


The Struggle for 1515 Fairmont .............................................. .... ............ ........... . E.7 


The Sidewalk Behavior Ordinance ...................................................................... E. 7 


Approach to Chronic Street Homelessness .............................. .......................... .............. E.9 


Program and Service Network ...... ................ .................... ............ ....................... E.9 


Involvement of Mainstream Agencies .......... ..... ................................................ E.l 0 


Who Is Served? ..................... ......... ............................................ ........................ E.13 


Coordination Mechanisms ................................................................................. E.14 


Pathways to Housing, Approaches and Models ................................................. E.16 


Documenting Success ............................... .. ................................................................... E.17 


Movement of Street Homeless into Housing ................ .... .. .. ...... ................. ...... E.18 


Selected System Components ........................................................................................ E.19 


Prevention ............ ................ ........ ........ .. ................... .............. ... .. ............ .......... E.19 


Outreach and Drop-in ............................. ............................................... ............ E.19 


Safe Havens and NolLow Demand Residences ................................... .............. E.20 


Emergency Shelters ........................................................................................... E.20 


Transitional Programs .................. .. .......................................................... .......... E.21 


Permanent Supportive Housing .............. ............................. .. ............................ E.21 


Street Counts ......... ............................ ............ ................. .. .................................. E.1 7 


VIII 
Table of Contents 

Supportive Services .......... .... ....... .......................... ... ................. ....... .. ............... E.21 


Affordable HOUSL'1g ................................................. ................... .. ..................... E.22 


Public Funding ............... ...... ..................................... _ ......................... ... .. ............. ....... E.23 


Maintaining and Enhancing the System ............................ ........................... ...... .......... . E.23 


Developing or Adapting New Approaches ........... ......... ........ ............................ E.24 


Budget Cuts .......................................... ..................... ........................ .. .. ............. E.25 


Community Relations and Advocacy .................................. ................. ... ......... ............. E.25 


Initial Resistance .................... .. .. ............................................ ............................ E.25 


Continuing NIMBY Issues ............. .............. ................ .. ............... .................... E.27 


Role of Consumers in Advocacy and Shaping Policy ....................... ........ ........ E.27 


Continued Vigilance .. ........................................ ................... .......... ................... E.29 


Site Visit Participants .................. ....... ............................................ .. ............................ .. E.30 


Acronyms .. ............................... .. ...................... .. ................. ............................. .............. E.34 


APPENDIX F: SAN DIEGO ..................................................................................................... F.I 


San Diego-Brief Description ............................ ............... ..... ....... ................. ................... F.I 


Practices of Potential Interest to Other Jurisdictions ..... .................... .......................... .. . F.2 


History and Context-How the Current System Evolved ... ................................... ........ ... F.3 


Approach to Chronic Street Homelessness ..................................... ................................. F.7 


Program and Service Network ......... ............ .. .... ... ..... .............................. .. .......... F.7 


Involvement of Mainstream Agencies ............... .................................................. F. 7 


Who Is Served? ........................................... ................................................. ........ F.8 


Coordination Mechanisms .......... ....................... .. ... ...... ...................... ................. F.8 


Pathways to Housing, Approaches and Models ......................... ............... ......... F.lI 


Selected System Components .................... ....... .......................... ........... ........................ F.II 


Outreach and Drop-in ....................... ............ ................................ ............... ...... F.I2 


Low Demand Transitional Residences ........ ................................................. .. ... F.I3 


PeITIlanent Supportive Housing ................... ............... ................ ....................... F.l3 


Supportive Services ........ .. .. ............. ............ ...................................................... F.I5 


Documenting Reductions in Chronic Street Homelessness ........................................ ... F.I7 


Movement of Street Homeless into Housing ...... .. ... .......................... ................ F.I7 


Public Funding ...................... ..... .. ....................... .................. .... ..................................... F.I8 


Maintaining and Enhancing the System ................................... ................. ............. ....... F.20 


Community Relations .... ........................................................................ ...................... .. F.20 


Site Visit Participants ..................................................................... ............... .......... .. ..... F.21 


Acronyms ... .................... .. ........................ .......... ............................ ... .. ................... ........ F.23 


Emergency Shelters ................. .. ......................................................... ............... F .12 


Transitional Programs ..................... .. ................................. .. .............................. F .13 


Affordable Housing ............ .. ................................ .......... ................................... F .16 


APPENDIX G: SEATTLE ....................................................................................................... G.I 


Seattle- Brief Description ........................... ................ ... ............ .............................. ......... G.I 


Practices of Potential Interest to Other Jurisdictions ................. .... ..................... ............. G.I 


History and Context- How the Current System Evolved .. ................ ....... ..... .. ................ . G.3 


The Continuum of Care Plan .. ... ...... .......................................... .................... ...... G.5 


Approach to Chronic Street Homelessness .. ..................... ..................... .. .. ........ .... .......... G.5 


IX 
Table of Contents 

Agency Interactions at the City and County Wide Level .... .......... ............... .......G.6 


Agency Interaction at the Case Level .............. .. .. .. ................. ............... .... ....... .. .G. 7 


Selected System Components .. ........... .. ............................................ ............................... G.8 

Prevention ........ .......................... ....... ......... .......... ........ .............. .... ... ................. ..G .9 

Outreach and Drop-in ..................... .... .......... ....................... ....................... _....... G.9 

Emergency Shelters Focused on the Chronic Street 

Homeless Population ......... ...... .. ........... ................................. ........ .. .. .. .........G.14 


Safe Havens and NolLow Demand Residences .............................................. ... G.15 


Case Management. ............ ..... ......................... .. ................................... .. ............ G .16 


Permanent Supportive Housing ......... ............ .......................... ...... _... ....." .. .... ..G.18 


Supportive Services ............ .......... .... ................................. ... ... ..................... ... .. G.22 


Affordable Housing ........ .. .......... .. ................... ....... .. ............ .... ... ........... .. ... ......G.23 


Documenting Reductions to Chronic Street Homelessness ... .. ............. ............. .. ... ... .... G.25 


Public Funding ........................ .. .. ................................ ........................................ ...........G.27 


Community Relations and Advocacy .................................... ........................................ G.29 


The Future-Maintaining and Enhancing the System .................. ................................... G.31 


Site Visit Participants ....................... ...... ...................... ...................... .. ......... .. ........ .......G.33 


Acronyms .............. .. ............... .... .................... .... .. ............... ... ...... ... ....................... ........G.35 


APPENDIX H: GLOSSARY ................................................................................................... H.1 


APPENDIX I: METHODS ................ _ ....................................................................................... 1.1 


Site Selection .................. ............... ................. .......................... ... .. ....................... ............. 1.1 


First Screening Round .................... ...... ................................. .. ........ ........ .............. 1.2 


Safe Havens ...... ................ ........... ........... ... ... ... .. .. ....................... ......... .. .. ............. 1.3 


Veteran Affairs Homeless Programs ................. .................... .... ........... ................ 1.3 


BID-Sponsored Programs ... .. ................................................................................ 1.4 


NIDA Demonstration Programs .. ........................... .... .. .................... .... ................ 1.4 


California's Integrated Services for Homeless Adults with 


Serious Mental Illness .. ......................................... ........ .. ........ ..... ........... ... ........ .. . 1.5 


New York City Programs ............ .. .. ............................ .. .. ......................... .. ........ .. . 1.5 


Other Pr..ograms ........... ....... ..... ................... ........................ .. ............... .. .............. .. 1.5 


Second Round Screening ............... ..................... .............................. .......... .. .. ...... 1.6 


Site Visits .. ..... ................... ........ .. ........................ .. .. .............. ...... ......... ....................... ...... I. 7 


Discussion Guide for use with Candidate Sites ............. .. ............... ......... .. ....................... 1.8 


History/Overview/Context Discussion Guide ... .. ............... ......... .. .......... ....... .. ............... 1.13 


Outreach-Caseworker Discussion Guide ......... .. .. ........................ .. .... .. .. ................. .. .. .... 1.16 


Data Issues Discussion Guide .. ................... ................... ....... ... ............ .............. .. .. ...... ... I.19 


Program-Specific Discussion Guide ............... .. ... .. ............... ........ ............... ................... 1.21 


Focus Group Discussion Guide for Participants of Programs to End 


Chronic Street Homelessness .......... ..... ........................................................ ...... ............. I.25 


REFERENCES ........................................................................................................................... J.1 


x 
Table of Contents 

LIST OF CHARTS AND TABLES 

Charts 

Chart 5.1: Counts of Street Homeless Individuals In Philadelphia, 1998-2003 ... ................ 52 


Chart 5.2: Counts of Street Homeless Individuals, Birmingham 1995-2003 .. ....................... 53 


Chart B.1: Strategic Homeless-Planning Group .................. ....... ............. ... ....................... .. .. B.6 


Chart C.l: Summary of 2003 Revenue Sources for Operations and 


Services Costs of Rebuilding Lives ..... ................... ................................... ........ e.22 


Tables 

Table 1: Key Elements Identified in Study Communities of Success Reducing 

Chronic Street Homelessness ............... ......................................... .. .... ...... ........... xix 

Table 2: Evidence of Success in Reducing Chronic Street Homelessness .. .. .................. xxvi 

Chronic Street Homelessness ...................... .. .... _ .............................................. .. . A.8 

Street Homelessness ........................ .... .. ...................... ...... ..................... ... ........ ... B.9 

Service Systems Used by Homeless Men with long-Term Needs .................. .... . CA 

Chronic Street Homelessness ... ....................... ....................... ......... ..................... e.6 

Table CA: Rebuilding Lives: Supportive Housing Projects .................. ... ......... .................. e.14 

Projects ............... .. ............. ........... ... .. ......... ....................... ..... .. .......................... C.15 

Operating or Funded ... ... ......................... .... ........... .............. ............................. .e.26 

Lives Units ........ ........................ ......................... .. .............................................. C.27 

Ending Chronic Street Homelessness ............................... ................ ............... .... D.6 

Table 5.1: Per-Bed Cost for Operations and Services of Franklin County 

Service Systems Used by Homeless Men with Long-Term Needs .... ................... 59 

Table 6.1: Federal Sources Invested in Ending Street Homelessness ..................................... 69 

Table 6.2: Potentially Underused Funding Sources For Ending Chronic 

Street Homelessness ................................................ ............ ................................... 75 

Table A.1: City of Birmingham: Agencies Involved in ReducinglEnding 

Table A2: Street Counts of Birmingham Homeless Population ............... ...................... ... A15 

Table A3: Local Agency Investments in Ending Street Homelessness .............................. AI7 

Table B.1: City of Boston: Agencies Involved in ReducinglEnding Chronic 

Table B.2: Boston Investments in Ending Street Homelessness ......................... ................ B.18 

Table e.l Per-Bed Costs for Operations and Services of Franklin County 

Table e.l: City of Columbus: Agencies Involved in ReducinglEnding 

Table e.3: Roles of Key Collaborators ............. ........ .. ....................................... .... ........... ... .. e.8 

Table e.5: Per Unit Costs (Operations and Services) for Rebuilding Lives 

Table e.6: Local Agency Investments in Ending Street Homelessness .............................. e.21 

Table e.7: Summary of Operations & Services for Projects Currently 

Table e.8: Total Estimated Funding Needs for Additional Rebuilding 

Table D.1: Department of Veterans Affairs Network of Agencies Involved in 

Table D.2: Supportive Housing Developed by the Greater Los Angeles 

VA and Community Partners .. .... ................... _...... ... .......... .... ........ .................... D.13 

Xl 
Table of Contents 

Table D.3: AB 2034 Network of Agencies Involved in Ending Chronic 

Street Homelessness ... ... ...................... .... .......... .. ..... .. ................ ........ ............ .... D.22 

Table D.4: Lamp Community Network of Agencies Involved in Ending 

Chronic Street Homelessness ......................... ... ................. .... ... .. ... .. .................. D.3l 

Table E.l: City of Philadelphia: Agencies Involved in Reducing/Ending 

Chronic Street Homelessness .. ................................... ..... ............... ... ............ ..... E.ll 

Table E.2: Local Agency Investments in Ending Street Homelessness ........... .. ................. E.24 

Table F.l : City of San Diego: Agencies Involved in ReducinglEnding 

Chromc Street Homelessness ........................... ................. ................................. .. F.9 

Table F.2: Local Agency Investments in Ending Street Homelessness .......... ... ............ ..... F.l9 

TableG.l: City of Seattle: Agencies Involved in ReducinglEnding 

Chromc Street Homelessness ...... .. ...... ................ ...... ..... .............. ... ... ..... ...........G.l 0 

Table G.2: Local Agency Investments in Ending Street Homelessness ........... ................... G.29 

xu 
EXECUTIVE SUMMARY 

Why This Study Is Important 

The goal of ending chronic homelessness has achieved national prominence in a very short time. 

It was fust articulated in July 2000, when the National Alliance to End Homelessness included it 

as part of its ten-year plan to end homelessness altogether. The Department of Housing and 

Urban Development (HUD) Secretary Mel Martinez announced his agency's acceptance of this 

goal in his keynote speech at the National Alliance's 2001 conference one year later. Then 

President Bush made "ending chronic homelessness in the next decade a top objective" in his FY 

2003 Budget. Also by 2003, the Interagency Council on Homelessness had been reinvigorated to 

guide and coordinate the efforts of Federal agencies, two New York Times lead editorials argued 

forcefully for that goal, the U. S. Conference ofMayors adopted it, and more than 100 cities and 

some states have committed themselves to developing a plan by 2004 to end chronic 

homelessness in the next 10 years. I 

HUD's goal, and the goal of many communities, is to end chronic homelessness. We have titled 

this report strategies for "reducing" chronic street homelessness because no community has yet 

succeeded in ending it, and we wanted the title to indicate that we are documenting progress, not 

complete success. This is an experimental time for programs to reduce chronic street 

homelessness. The many communities that have resolved to end chronic homelessness have to 

learn about successful approaches,2 construct their own strategies, and locate the necessary 

resources to fulfill their plans. These communities can benefit from the experiences of homeless 

service providers who have been willing and able to participate in developing and implementing 

new approaches. Given the scope of what needs to be done, integrated community-wide 

approaches hold the most promise of succeeding. 

HUD sponsored this project to identify and describe community-wide approaches that are 

working in cities around the country.3 We selected seven communities that were reputed to have 

made progress in reducing their chronic street homeless popUlation and would be able to 

document that progress. After conducting site visits, we found that only three of the seven have 

developed a true community-wide paradigm, but that each of the seven communities had 

noteworthy strategies to reduce chronic street homelessness. We also discovered common 

elements in the seven communities' approaches that appear to maximize progress. This report 

describes these common elements and their role in approaches to reducing chronic street 

homelessness. Communities just beginning to develop their own plans for reducing chronic 

'For examples, see State and Local Plans to End Homelessness at the National Alliance to End Homelessness 

webpage http://www.endhomelessness.org/localplans/. 

2 Throughout this report we use the term "approach" to indicate the set of strategies and mechanisms of coordination 

being employed by a cOlrummity to reduce chronic street homelessness. 

3 HUD's Policy Development and Research Office funded the study, in consultation with the Office of Special 

Needs Assistance Programs/Community Planning and Development, which administers HUD's homeless-related 

programs and funding opportunities. 

Xlll 
Executive Summary 

homelessness should be able to fmd illustrative practices and programs that they can learn from 

and adapt to their own situations. 

Purpose of the Research 

This project's aim was to identify successful community-wide approaches to reducing 

homelessness and achieving stable housing for the difficult-to-serve people who routinely live on 

the streets. It was also to document these successful approaches in a way that will help other 

communities trying to address this problem. We included as "street homeless" single adults who 

spend significant time on the streets, although they may also use emergency shelters from time to 

time. Most of the people to be helped will also be "chronically" homeless, which we defined as 

being disabled and either being continuously homeless for a year or more or having had at least 

four homeless episodes during the last three years. This definition of "chronic" homelessness 

corresponds to the definition recently adopted by the Interagency Council on Homelessness. 

Disabilities or disabling conditions often include severe and persistent mental illness, severe and 

persistent alcohol and/or drug abuse problems, and HIV/AIDS. To the extent that community 

approaches address these, they can assist a greater proportion of chronic street homeless people 

to leave homelessness. 

This study sought to answer several questions about strategies that communities use to reduce 

chronic street homelessness: 

• 	 Does the community have a long-term plan for reducing/preventing chronic 

homelessness? What is its approach and what are the elements? What led to this approach 

and how was it identified? What needs of which homeless people does it address? 

• 	 How was the approach implemented? What challenges were encountered? What 


opportunities were used? 


• 	 How is the approach administered and coordinated? What is the role of each stakeholder? 

• 	 How is the approach funded? Do requirements of the funding sources create any barriers 

or promote any successes? 

• 	 Did implementation include efforts to reduce local resistance by including community 

members? How? How successful have these efforts been? 

• 	 Can the community document its progress, either by showing that the numbers of street 

homeless people have decreased or by showing that programs are accepting this 

population and helping them leave homelessness? 

• 	 How else do communities use data to bolster their case for making the investment to end 

chronic street homelessness? 

XIV 
Executive Summary 

Who, What, Where, and When? 

In 2002, HUD contracted with Walter R. McDonald Associates, Inc. and its subcontractor, the 

Urban Institute, to conduct a study to answer the aforementioned research questions. We sought 

communities appropriate for site visits through recommendations of key informants and a 

literature search for evaluated projects, identifying over 120 possible programs and communities. 

We called community and program representatives to help us identify appropriate communities 

to visit Criteria for selection included that the community have an approach to reducing chronic 

street homelessness, that it be community-wide, and that there be evidence to document that the 

approach actually succeeded in reducing chronic street homelessness. 

HUD asked us to fmd community-wide approaches to reducing chronic street homelessness 

because its analysts suspected that such a focused commitment might be necessary for 

substantial progress. For our purposes, "community-wide" means that a jurisdiction such as a 

city or a county has made a conscious commitment to reducing chronic street homelessness (as 

opposed to all homelessness), and has mobilized resources for that specific purpose. We were 

able to fInd three communities that met all three criteria, and several others that met the criteria 

but only for specific subpopulations such as veterans, people with severe mental illness, or 

people with co-occurring disorders. We visited some communities that did not meet the criterion 

of having a community-wide approach because we reasoned that many communities throughout 

the country would benefIt from knowing what could be accomplished even without a 

community-wide approach, as not all communities will be able to begin with a community-wide 

commitment. The seven communities visited were: 

• 	 Binningham, Alabama; 

• 	 Boston, Massachusetts; 

• 	 Columbus, Ohio; 

• 	 Three projects in Los Angeles, California--one focused on homeless veterans, one 

focused on mentally ill offenders in the county jail system, and one focused on chronic 

street homeless people in the downtown "Skid Row" area; 

• 	 Philadelphia, Pennsylvania; 

• 	 San Diego, California; and 

• 	 Seattle, Washington. 

We conducted site visits to each of these communities, ranging in length from two to fIve days 

depending on the complexity of the community's approach and the components we chose as the 

focus of our visits. We interviewed between 40 and 90 people per site, including focus groups at 

each site of 5 to 10 formerly street homeless people. Representatives at each site had the 

opportunity to review for accuracy our description of their community and its activities for 

reducing chronic street homelessness (which appear as Appendices A through G). 

Findings-Key Elements of Success 

We identifIed 11 key elements in the seven communities visited, shared by many approaches for 

reducing chronic street homelessness. Most important, we found fIve of these elements to be 

xv 
Executive Summary 

present in the communities that have made the most progress toward reaching tills goal, and have 

called these elements "essential." 

Themost important element, shown in the fust row of Table 1, is (1) a paradigm sillft in the 

goals and approaches of the homeless assistance network. The essential recognition underlying 

the paradigm shifts we observed was that existing approaches and homeless assistance networks 

were not reducing or ending homelessness, particularly chronic or street homelessness.4 

Recognizing also that they wanted to end chronic street homelessness, these communities 

adopted that goal and found new or modified existing approaches that brought greater success. 

We did not fmd any connection between having a well-established homeless assistance network 

and experiencing a paradigm sillft; the fust was not a prerequisite for a shift, nor did it guarantee 

that one would occur. Among the communities we visited, four (Boston, Columbus, 

Philadelphia, and Seattle) have extensive programs and services in every aspect of their 

continuum of care, run by experienced providers and developed over many years with both 

Federal and local funding and support. Two of the four have experienced a paradigm shift willIe 

two have not yet done so. While having a well-developed network does not produce a shift, 

however, once a sillft occurs an established and extensive network of services and providers that 

work well together offers an advantage as a community proceeds with the planning and program 

development needed to launch new approaches. This is what happened in Columbus and 

Philadelpilla. On the other hand, San Diego's homeless assistance network had major gaps, 

especially in the area of permanent supportive housing. The pre-sillft system was developed 

by the local network of nonprofit agencies, without much focus on the chronic street popUlation 

and without much participation by the public and business sectors. San Diego's paradigm sillft 

involved both a new focus--on the chronic street population-and new players-public agencies 

and the business community. 

The next four elements appear to comprise an important combination that, working together, tum 

a paradigm sillft's promise into a reality. These are (2) setting a clear goal of reducing chronic 

street homelessness, (3) committing to a community-wide level of organization, (4) having 

leadership and an effective organizational structure, and (5) having significant resources from 

mainstream public agencies that go well beyond homeless-specific funding sources. It is 

important to note that these elements characterize community activities to reduce chronic street 

homelessness after a paradigm shift, but need not already be in place. Some may exist before the 

shift (Columbus and Philadelphia had all except the goal of ending street homelessness). We 

observed the most progress toward ending chronic street homelessness at the community level 

where these elements worked together as they did in Columbus, Philadelphia, and San Diego. 

Even when an organization or network experiences a paradigm sillft affecting a sUbpopulation 

rather than a whole community, we found these same four elements as the engine underlying 

their success in building on their paradigm shift, as they did in two examples from Los Angeles 

(the work of the Department of Veterans Affairs with homeless veterans and the Mental Health 

and Sheriffs Departments' joint work with mentally ill offenders). 

4 The old paradigm was that street homeless individuals should be cared for more by charitable, often religious, 

organizations rather than by mainstream public agencies. The old paradigm relied heavily on emergency shelters, 

transitional housing, and sobriety-based programs. The old paradigm did not plan, or expect, to end chronic street 

homeiessness. 

XVI 
Executive Summary 

The flISt five elements, working together, allowed several of our communities to capitalize on a 

trigger event or catalyst, while in at least one other, a trigger event was the catalyst for 

developing the [lIst five elements. The remaining elements in Table I contributed to a 

community's ability to sustain its commitment and guide the development of its new approaches. 

These are (7) significant involvement of the private sector; (8) commitment and support from 

mayors, city and county councils, and other local elected officials; (9) having a mechanism to 

track progress, provide feedback, and support improvements; (10) being willing to try new 

approaches to services, and (11) having a strategy to handle and minimize negative reactions to 

locating projects in neighborhoods (NIMBY responses). 

How They Got Where They Are Today-Key Factors in History and Implementation 

All successful community and sUbpopulation approaches started from one place-key 

stakeholders recognized that to end chronic street homelessness, they had to focus specifically on 

that goal, understand the characteristics of chronically street homeless people, and plan programs 

and services designed to attract them. Even in communities that had a well-established homeless 

assistance network, stakeholders realized that they were not reducing or ending chronic street 

homelessness, and would have to do things differently if they wanted to succeed. As already 

described, they underwent a paradigm shift in the way they approached homeless assistance 

programs and services for the hardest-to-serve chronically homeless people. 

Trigger Events and Paradigm Shifts 

In most of the communities we visited, a trigger event galvanized the approach we observed. The 

event was impending downtown development in Columbus and San Diego, a proposed antihomeless city ordinance in Philadelphia and Birmingham, consumer and service provider 

protests at the Department of Veterans Affairs in Los Angeles and municipal buildings in 

Philadelphia and San Diego, and an invitation to develop a pilot program for a new funding 

source for the Los Angeles County Sheriff and Mental Health Departments' integrated services 

program. The two communities that already had strong organizational structures and leadership 

(Colwnbus and Philadelphia) were able to capitalize on these trigger events with relative ease 

and speed. But it is important to note that several communities and public agencies that did not 

have an organized leadership structure or well-developed public agency involvement and 

investment before the trigger event (for example, San Diego and two of the Los Angeles 

programs) were able to use the event to re-examine their situation, decide to take action, organize 

themselves, mobilize resources, and make and carry out plans for approaches that address and 

reduce chronic street homelessness. Thus these four communities were able to turn these events 

to their advantage and gain commitments to new goals and new resources, rather than allowing 

the event to worsen the circumstances of street homeless people. The event itself is often 

perceived locally as a watershed moment-the catalyst that began the process that resulted in the 

current commitment to reduce or end chronic street homelessness. 

XVll 
Executive Summary 

Table 1: Key Elements Identified in Study Communities of Success in Reducing Chronic Street H

Essential 

providers 

Strong Strong Strong Weak 	 

Progress-tracking Yes 

Mechanism 

New Approaches to Yes 

Services Strategy to Combat Some Some 

NIMBY 

lin Columbus, Philadelphia, San Diego, Birmingham, Boston, and Seattle, we sought community-wide approaches to ending chronic street homelessness, In Los Angeles, we did not look for a countywide 

inslead two systems focused on particular subpopulalions of inlerest and one mini-<:ontinuum focused exclusively on chronically street homeless people, 

XVIII 
Executive Swnmary 

Even in communities that have not, as yet, adopted reducing chronic street homelessness as a 

community-wide goal, some networks have developed with a focus on reducing homelessness 

among chronically street homeless people in response to unique -opportunities or the commitment 

of a public agency. Seattle used the ACCESS program targeting severely mentally ill homeless 

people to help create a service network that still operates -to the advantage of mentally ill street 

people, and also developed a set of programs and services targetecLspecifically toward substance 

abusing street homeless people. In Boston, the Massachusetts Department of Mental Health has 

committed extensive resources to programs and services for homeless people with se\Lere mental 

illness, including specialized emergency and transitional shelters/housing and extensive 

discharge planning to avert a return to homelessness after psychiatric treatment. 

It takes the change in vision-the paradigm shift in what communities are trying to 

accomplish-to make significant progress toward reducing chronic street homelessness within a 

community or for a subpopulation. Excellent individual programs will surely exist-we visited 

many of them-and they may have great success in helping individual homeless people leave 

homelessness. But without the paradigm shift, communities probably will not take the steps to 

develop innovative approaches and mobilize the resources that are necessary to reduce chronic 

street homelessness. 

Thoughtful, Analytic Process 

The approaches making the most progress toward ending chronic street homelessness were based 

on an extensive investigation of needs and options. Decision makers learned about the numbers, 

problems, and service needs of their chronically homeless population, through special surveys, 

focus groups, and "hanging out." They read evaluation reports and visited other communities 

that already had approaches they were considering. They invited speakers to town to discuss 

options. Columbus and Philadelphia provide examples of this analytical process. They each had 

community-wide data on emergency shelter use from which they learned that 10 to 15 percent of 

the people who used emergency shelters throughout the year used 50 percent or more of shelter 

resources (bed nights). They reasoned that if they could move these chronically homeless people 

into permanent housing arrangements, both they and the homeless assistance system would 

benefit. 

Armed with pertinent information, the more advanced communities developed an approach that 

in all instances involved strategies to address both "opening the back door" (helping people leave 

homelessness) and "closing the front door" (preventing people from becoming homeless). 

Strategies of both types require the active cooperation and investment of mainstream agencies. 

Building this commitment occurred through various approaches, depending on the community. 

In Columbus, which already had a central organization and involvement of mainstream agencies, 

the route was through a special project, Rebuilding Lives, which included a survey of street 

homeless people and analysis of the results and their implications for the types of programs and 

XIX 
Executive Summary 

investments that would be needed. The final report addressed the whole community, explained 

the strategy and its rationale, anclorganized buy-in from many stakeholders to develop 800 units 

of low-demand permanent supportive housing explicitly for the chronically homeless people in 

shelters and on the streets, to augment the community's existing array of permanent supportive 

housing. 

In contrast, San Diego began without an existing central organization coordinating the efforts of 

its mainstream public agencies. Interested parties organized informally, took their time, talked 

with everyone, and aliowed consensus to grow as increasing numbers of public agencies and 

private interests were invited to participate. Ultimately the plan they developed received 

unprecedented endorsement and support from both city council and county board of supervisors, 

plus significant business commitments. Finally, communities with successful approaches set 

goals and timetables, put someone in charge, track their progress, make sure they get feedback 

on how they are doing, and periodically take time to reflect on progress and what adjustments or 

new commitments might be required. 

New Strategies for Programs and Services 

Most of the communities we visited have assessed and adopted new approaches to programs and 

services for the street homeless population, or have modified existing ones (as a result of the 

thoughtful, analytic process). They have also increased commitments to existing programs and 

services to better approximate the level of need among chronically street homeless people, who 

include many of the hardest-to-serve homeless people. They have severe mental illnesses, 

substance abuse disorders, HfV / AIDS, and physical disabilities, often occurring together. They 

have been homeless a long time, often have no ties to family, and rarely have any resources. 

Their skills are oriented toward survival on the streets, not to living in housing. 

Most chronically street homeless people have used emergency shelter-some only briefly, but 

others for long periods of time. Many have been frequent users of detoxification facilities, and 

have had some contact with the mental health system as both outpatients and inpatients. Many 

will not use programs that require sobriety to enter, as they will not stop using drugs and alcohol, 

at least at first. In addition many are not able to comply with plans or "make progress" from the 

time they enter a program, as many transitional programs require them to do. The long stays of 

people in emergency shelter clearly indicate that emergency shelters generally do not succeed in 

moving these people out of homelessness. 

The people on whom this project focuses are, by definition, those for whom these programs and 

services have not produced long-term solutions to homelessness. Their resistance to standard 

approaches has been a challenge to communities committed to ending chronic street 

homelessness. In the experience of the communities we visited, reaching that goal has required 

rethinking their services and offering new approaches. Most communities we visited have 

adopted one or more of: 

• 	 Housing First models that place people directly from the streets into permanent housing 

units with appropriate supportive services, including safe haven programs for people with 

xx 
Executive Summary 

serious mental illness and similar programs for people whose primary problem is 

addiction; 

• 	 Transitional versions of Housing First that let people bypass emergency shelters; 

• 	 Breaking the linkage between housing and service use/acceptance, so that to keep 

housing, a tenant need only adhere to conditions of the lease-(pay rent, don't destroy 

property, no violence), and is not required to participate in treatment or activities; 

• 	 Low demand or "harm reduction" conditions where sobriety is "preferred but not 

required," which often translate into a "no use on the premises" rule for projects that use 

HOD funds; and 

• 	 Restructuring existing activities such as outreach to increase their effectiveness at 

connecting street homeless people with services and housing; and 

• 	 Discharge planning from jails and mental health hospitals to prevent street homelessness 

among individuals leaving these institutions. 

In addition, many communities have developed mechanisms for facilitating service delivery to 

individual clients, helping them to take advantage of what the system has to offer. Some of these 

are specialized versions of case management, and some are tools to support effective case 

management. They include: 

• 	 Database technology and information sharing that allows staff members of one agency to 

know what services a client might be receiving from other agencies; 

• 	 Multi-agency teams designed to include the range of expertise required to meet the broad 

spectrum of services needed by chronic street homeless individuals; 

• 	 Multi-purpose service centers where clients can receive more than one type of service 

within the same building; and 

• 	 Processes to improve access to mainstream agencies, such as locating intake workers at 

homeless service provider sites. 

Low-demand housing approaches appear to be very successful at attracting chronic street 

homeless people. According to focus groups with street homeless people and outreach workers 

during our site visits, as well as other research (Rosenbeck et aI., n.d.; Shem et aI., 1997; 

Tsemberis and Eisenberg, 2000), these low-demand programs can bring difficult-to-recruit 

individuals into permanent supportive housing. People will come in, they do use services even 

though not required to, they do reduce their substance use, and mostly they do not return to the 

streets. Other mechanisms facilitate the process of recruiting people into the housing programs 

and assuring that, with maximum efficiency and effectiveness, they get the array of services they 

need. 

XXl 
Executive Sununary 

In addition to the new approaches, making a commitment to ending chronic homelessness often 

means increasing the availability of existing programs and services that help people toJeave 

homelessness. Such actions might include increasing access to case managers and reducing case 

manager caseloads. Short-term and medium-term addiction recovery programs might be 

expanded to fill gaps, so that people are not left without a program when they are not yet secure 

in their recovery. The availability of housing subsidies might be expanded. It takes many 

components to create a successful system. Some will be new, others old. Birmingham, for 

instance, has some successful programs based entirely Oll sobriety and transitional rather than 

permanent supportive housing. But serious commitment to ending chronic street homelessness 

necessitates a paradigm shift, part of which involves the willingness of a community and its 

homeless assistance providers to consider approaches that have been proven to work even though 

they may, at least initially, represent a significant departure from traditional programs. 

Documenting Progress 

We sought out programs and communities that not only were doing important things to end street 

homelessness, but also had the evidence to document their progress. Collecting such evidence is 

not easy, and it can take many forms: 

• 	 Changes in the number of people found on the street from year to year, coming from 

consistently administered and analyzed street counts; 

• 	 Increases in the percentage of chronically street homeless people who 

~ Move directly from street to permanent supportive housing, or other combinations 

of services that lead to permanent housing in the community (for example, safe 

havens and then PSH); 

~ Receive other combinations of services that lead to permanent housing in the 

community (for example, transitional housing followed by moving into affordable 

housing with decreasing supportive services, for people in recovery where 

substance abuse is the primary issue); 

• 	 Costs avoided by reducing inefficient utilization by homeless people of health, mental 

health, shelter, and law enforcement services; 

• 	 Reductions in undesirable outcomes for homeless people (such as days homeless, 


hospitalized, or incarcerated); 


• 	 Increases in receipt by homeless people of entitlement public benefits (such as 


Supplemental Security Income, Medicaid, or food stamps); and 


• 	 No reappearance in the homeless service system (documented through a community-wide 

homeless management information system). 

Many factors may influence the level of homelessness, including street homelessness, in a 

community, no matter how organized or complete the efforts to end it. In the communities we 

visited, interviewees attributed increases in the level of chronic street homelessness or changes in 

XXll 
Executive Summary 

other measures of progress to a poor economy and resulting unemployment, shutting down one 

or more large SRO hotels where-poor single people had lived, closure of state mental hospitals, 

and persistently high housing costs. 

Even in the face of these countervailing factors, the communities we visited were able to 

substantiate their progress at reducing chronic street homelessness, or helping chronically street 

homeless people obtain housing, in a variety of ways (see Table 2). Other communities might be 

able to develop the types of evidence shown in Table 2, which they could use to convince local 

stakeholders that investing in programs and services to reduce clrronic street homelessness will 

produce measurable results. 

Philadelphia and Birmingham street counts show reductions over a number of years, with 

Philadelphia's decreases paralleling increases in safe haven and permanent supportive housing 

units, and Birmingham's paralleling increases in both transitional and permanent supportive 

housing, as well as emergency shelter expansion. 

As shown in Table 2, at least some programs in most communities can document progress in 

bringing clrronically street homeless people into supportive housing and in helping them retain 

that housing. Lengths of stay in programs that have been in operation long enough for tenants to 

remain stably housed for years average tlrree to five years. Some programs can also document 

the proportion of leavers who went to and remained in affordable housing in the community. In 

one Philadelphia program 67 percent of 90 people who left permanent supportive housing were 

living in "regular" affordable housing. 

Columbus, Philadelphia, and San Diego have also made good use of cost data to show the most 

cost-effective models of providing services (Columbus) orthe cost of emergency services that 

could be avoided through permanent supportive housing (Philadelphia and San Diego) or 

transitional housing and treatment for serial inebriates (San Diego). Cost avoidance studies 

showing that PSH does not cost much more than "doing nothing" have recently achieved 

national prominence (Culhane, Metraux, and Hadley, 2002; Rosenheck et aI., 2003), and can be 

considered a more humane investment of public funds. These results are one reason why an 

increasing number ofjurisdictions are committing themselves to ending chronic homeless ness. 

How Do They Pay For It? 

Finding the resources to pay for new programs and services is always a challenge. The 

experience of these seven communities indicates very strongly that reducing chronic street 

homelessness requires significant investment of mainstream public agencies, bringing both their 

commitment and energy, and local dollars. The goal cannot be met if the homeless assistance 

network providers are the only players, and Federal funding streams the only resources. 

The communities and service networks enjoying the greatest success in reducing clrronic street 

homelessness all capture resources from many different funding streams. The local agencies that 

control these funding streams have made the decision to devote not only Federal resources they 

control, but also their own state and local resources, to achieving the goal. In addition, some 

communities have created special funding streams that help support permanent housing 

programs and supportive services. These include a housing tax levy (Seattle), tax increment 

XXlll 
Executive Summary 

financing generated by a redevelopment agency and reinvested in permanent supportive housing 

(San Diego), community redevelopment bonds (Philadelphia), special state funding streams 

(California'S Integrated Services for Homeless People with Mental Illness, and its Supportive 

Housing Initiative Act), and investments by Business Improvement Districts and other 

associations of downtown businesses and corporations (Binningham, Columbus, Philadelphia, 

San Diego). 

Implications 

The fmdings from this project have some important implications for policy, practice, and 

research. We summarize them here. 

Implications for Policy 

During site visits many respondents offered suggestions for how Federal policy and Federal 

agencies could help them as they pursue their goal of ending chronic homelessness. Their 

suggestions reflect their own experiences of what has helped them, and also what they feel could 

continue to ease the way toward reaching their goal. These include suggestions for Federal, state, 

and local agencies. 

• 	 Federal agencies should: 

~ Continue to prioritize community-wide planning and integrated approaches for 

reducing chronic homelessness in general, and street homelessness for people 

with severe mental illness, chronic substance abuse, HIV IAIDS, or any 

combination in particular; 

~ Make technical assistance widely available to communities that are starting to 

plan an approach to reducing street homelessness; and 

~ Facilitate opportunities for practitioners and planners to observe new approaches 

in action, speak with consumers, see results, and consider how these practices 

could be applied in their own community. 

• 	 Federal legislative action should increase the flexibility of Federal agencies to blend their 

funding to support innovative community-wide practices that integrate services to reduce 

chronic homelessness across local agencies. 

XXIV 
Executive Summary 

TABLE 2: EVIDENCE OF SUCCESS IN REDUCING CHRONIC STREET HOMELESSNES

enrollees were mentally ill 

chronically homeless, now in 

H; most of other enrollees are 

TH 

Formerly street 

homeless people moved to permanent 

affordable "regular" 

housing 

l-of 90 who left PSH, 67% 

Estimates cost of chronic shelter 

use vs. PSH, safe havens 

11. Fifteen high medical service 

users cost $1.5 million over 18 months 

2. One arrest for a serial inebriate 

$1470 versus $977 for a 

of TH plus outpatient 

Reduced emergency beds 

more PSH and Safe Havens 

One program reports that after 1 

year participants had 73% fewer 

days homeless, 35% fewer days 

hospitalized, 55% fewer days 

housing and 

have not retumed 

16-25% fewer 65% fewer days 

homeless days homeless, 74% fewer 

(national VA days hospitalized, 

study); 80% fewer days 

fewer hospital 

xxv 
Executive Summary 

• 	 State and local agencies should: 

~ Adjust rules and regulations to facilitate access to benefits, programs, and services 

for chronically street homeless -people; 

~ Establish procedures and invest resources in housing and services to assure that 

people leaving psychiatric care, substance abuse treatment, correctional facilities 

or foster care do not become homeless; and 

~ Facilitate state and local public agency and nonprofit provider interest in and 

capacity to serve clients with co-occuning disorders, by, for example, improving 

liaison and integrated service arrangements among mental health, substance 

abuse, medical care, and housing authorities; or requiring dual certification for all 

contract agencies and staff. 

Implications for Practice 

One of the primary reasons for conducting this study was to learn what different communities 

actually do that is effective in reducing street homelessness. The practice implications 

summarized here are distillations of information, opinion, and experience from many of the sites 

we visited. Communities desiring to advance in their efforts to end chronic homelessness, 

including street homelessness, should look carefully at the experiences of the places we visited 

and explore how they may adapt proven practices to their own situation. The body of this report 

includes "practices of potential interest to other communities," complete with people to contact 

to learn more, and contact information. Brief descriptions occur throughout the report, but details 

may be found in the site appendices, which begin with brief summaries and contact information. 

Readers should browse these appendices to learn about practices and see whether any of them 

might be appropriate for their own community. 

• If a community is intent on reducing chronic street homelessness, it is vital that it take 

steps to build the capacity to work with people who have co-occuning disorders. 

~ Homeless providers need to develop dual competence and dual certificationmental illness and substance abuse issues must be handled together. 

~ Mainstream mental health and substance abuse agencies need to have an 

integrated approach to mental illness and substance abuse for chronically street 

homeless people. Mainstream agencies also need to accept that stable housing 

contributes to their clients' well being-possibly as much as medications and 

other official "treatments." They should consider creating positions of housing 

developers and coordinators, and making housing and housing stability a priority. 

~ Housing providers need to understand the benefits of supportive services to their 

whole tenant base and not just to those who were homeless. In the communities 

we visited, some housing providers had realized the advantages of having 

supportive services available. The Plymouth Housing Group of Seattle reported 

that their tenants' average tenure increased from 18 months to 36 months, once 

XXVI 
Executive Summary 

services were made available. Services associated with Shelter Plus Care were 

located at Sunshine Terrace in Columbus, a high-rise 180-unit building operated 

by the public housing authority, to provide support to the tenants who receive 

Shelter Plus Care subsidies (about one-fourth of all tenants). Other tenants may 

and do use these services, resulting in stabilized housing tenure for all tenants, as 

well as contributing to the good neighbor image Columbus cultivates for its 

pennanent supportive housing programs. 

• 	 To develop and implement strategies for reducing chronic street homelessness, 

communities require strong, skilled leadership. The institutional location ofthe leaders is 

not as important as the capability and commitment of the individuals. But individuals, 

however good their leadership skills, must have the backing and resources of local 

mainstream agencies and elected officials if they are to succeed. 

Implications for Research 

The implications of our study for research are not as direct as those for policy and practice. They 

stem more from what we did not fInd, and what we could not document, than they do from what 

we were able to see and evidence we were able to collect. As we examined our [mdings, many 

gaps in knowledge appeared-types of evidence we wish we had, or wish were stronger, to 

establish with greater confidence which directions and practices were fruitful and should be 

emulated in other communities. The research suggestions presented below are those that we 

think will help fill the most glaring gaps in our current knowledge and provide the most useful 

infonnation to show effective approaches to ending chronic street homelessness. 

• 	 Longitudinal tracking studies should be funded to document housing stability and follow 

people once they leave supported housing. A primary outcome to observe in this research 

would be housing stability and what factors contributed to it. These studies would be 

most relevant to conduct for fonnerly street homeless people with severe mental illness 

and co-occurring disorders. They should examine housing stability both within the 

homeless assistance network and after leaving it. 

• 	 Conduct research that compares the effectiveness and cost-effectiveness of different 

pathways into permanent housing for different sUbpopulations. Ideally this research 

should use random assignment intervention studies; if that is impossible, it must employ 

meaningful comparison groups. 

~ Pathways to examine should include (1) directly from the street into pennanent 

supportive housing, (2) transitional housing as a step before pennanent supportive 

housing, (3) safe haven as a step before pennanent supportive housing, and (4) 

transitional housing with expectation of movement into affordable housing in the 

community (no supportive services). 

~ Approaches to test, within pathways, should include (1) sober versus hann 

reduction models, (2) voluntary versus coerced treatment (the latter through drug 

court or its equivalent), (3) different physical structures and service delivery 

XXVll 
Executive Summary 

mechanisms (for example, scattered site, only-formerly-homeless single site, and 

mixed-use single site), and (4) if transitionaL housing is part of the pathway being 

tested, what is the optimal duration of transitional housing to increase the odds of 

maintaining recovery. 

• 	 Support a reasonable sample of permanent supportive housing providers to collect and 

maintain better data on their tenants, and assemble these data at the national level. This 

approach would be less expensive by far than the ideal research designs described in the first 

two bullets, but would still contribute significant new data on important issues, including the 

effectiveness of permanent supportive housing. Data would need to be collected (1) at intake 

about tenant histories, (2) during residence, and (3) after people leave permanent supportive 

housing, to document continued success or return to homelessness. To give this approach the 

greatest chance to contribute high quality information, a national research effort would have 

to be established to manage data collection within programs and conduct the follow-up 

interviewing, if one wanted to assure acceptable completion levels. 

XXVlll 
CHAPTER 1: INTRODUCTION 

Why This Study Is Important 

Today's recognition of homelessness as a social problem is about two decades old. First 

responses were to treat the problem as an emergency situation. Policy evolved over the years to 

include recognition that many of the people finding themselves homeless would need more than 

an emergency bed for a few nights, weeks, or even months to get themselves back into regular 

housing. Some communities began as early as the late 1990s to reorient themselves toward 

ending either chronic homelessness or all homelessness, and to establish action steps and a time 

frame in which to do so. 

At its national conference in July 2000, the National Alliance to End Homelessness unveiled a 

ten-year plan to end homelessness altogether. A significant part of that plan is a blueprint to end 

chronic homelessness in the same time frame. The plan drew on evaluations that show we know 

how to create programs and supportive services to bring people in off the streets and help them 

retain housing, and on research that estimates the number of chronically homeless people to be 

few enough (between 150,000 and 250,000) to make a reasonable target for a successful policy. 

Two years later, additional research (Culhane, Metraux, and Hadley, 2002) showed that the 

policy might be close to cost-neutral in public monies as well. Since 2000, this goal of ending 

chronic homelessness has expanded dramatically. By 2003 the President had endorsed it and 

reinvigorated the Interagency Council on the Homeless to guide and coordinate the efforts of 

Federal agencies. Two New York Times lead editorials argued forcefully for that goal, the U. S. 

Conference of Mayors had adopted it, and more than 100 cities and states around the country had 

committed themselves to developing plans that would make it a reality. 

These plans usually have at least two aspects-helping chronically homeless people leave 

homelessness for good by establishing permanent supportive housing or other supportive 

networks, and stopping the flow of people likely to experience chronic homelessness by offering 

housing and appropriate supports for vulnerable people leaving institutions such as substance 

abuse treatment, psychiatric, or correctional facilities. 

This is an experimental time for programs to reduce chronic street homelessness. The many 

communities that have resolved to end chronic homelessness have to learn about successful 

approaches,5 construct their own strategies, and locate the necessary resources to fulfill their 

plans. These communities can benefit from the experiences of homeless service providers who 

have been willing and able to participate in developing and implementing new approaches. 

Given the scope of what needs to be done, integrated community-wide approaches hold the most 

promise of succeeding. 

5 Throughout this report we use the teon "approach" to indicate the set of strategies and mechanisms of coordination 

being employed by a community to reduce chronic street homelessness. 

1 
Chapter 1: Introduction 

HOD sponsored this project to identify and describe community-wide approaches that are 

worki.'1g in cities around the country.6 We selected seven communities that were reputed to have 

made progress in reducing their chronic street homeless population and would be able to 

ducument that progress. After conducting site visits, we found that only three of the seven have 

developed a true community-wide paradigm, but that each of the seven communities had 

noteworthy strategies that were working to reduce chronic street homelessness. We also 

discovered common elements in the seven communities' approaches that appear to maximize 

progress. This report describes these common elements and their role in approaches to reducing 

chronic street homelessness. Communities just beginning to develop their own plans for reducing 

chronic homelessness should be able to fmd illustrative practices and programs that they can 

learn from and adapt to their own situations. 

We found that the most successful of the study communities had experienced a paradigm shift 

that changed the goals and approaches of their homeless assistance network. This was especially 

powerful when combined with having a clear goal of reducing chronic street homelessness, a 

community-wide level of organization, strong leadership and effective organizational structure, 

and significant resources from mainstream public agencies. These and other key elements are 

described in detail in Chapter 2. The other chapters in the body of the report describe how the 

study communities implemented their strategies. The last chapter describes policy, practice, and 

research implications. 

The site visit appendices provide descriptions of how the elements operate together in each of the 

study communities. These appendices also include site contact information for practices of 

potential interest to other jurisdictions. None of the study communities have achieved the fmal 

goal of ending chronic homelessness, but all provide examples of useful strategies. A few of our 

study communities have a more complete approach than the others, but all of them are working 

on improvements. 

Purpose of the Research 

This project's aim was to identify successful community-wide approaches to reducing 

homelessness and achieving stable housing for the disabled, difficult-to-serve people who 

routinely live on the streets, and to document these successful approaches in away that will help 

other communities trying to address this problem. We included as "street homeless" single adults 

who spend significant time on the streets, although they may also use emergency shelters from 

time to time. Most of the people to be helped will also be "chronically" homeless, which we 

defmed, as does the Interagency Council on the Homeless, as being disabled and either being 

continuously homeless for a year or more or having had at least four homeless episodes during 

the last three years. We use the phrase "chronically street homeless" in describing those single 

adults who meet both criteria. To be successful at the task of reducing chronic homelessness, 

community approaches must address disabilities such as severe and persistent mental illness, 

severe and persistent alcohol and/or drug abuse problems, and mY/AIDS. For succinctness of 

6 HUD's Policy Development and Research Office funded the study, in consultation witb the Office of Special 

Needs Assistance Programs/Community Planning and Development, which administers HUD's homeless-related 

programs and funding opportunities. 

2 

~-

Chapter 1: Introduction 

writing, often in this report we will simply use the terms "chronic homelessness" and 

"chronically homeless individuals" in referring to the people who are the focus of our inquiry. 

This study sought to answer several questions about strategies that communities use to reduce 

chronic street homelessness: 

• 	 Does the community have a long-term plan for reducing/preventing chronic 

homelessness? What is its approach and what are the elements? What led to this approach 

and how was it identified? What needs of which homeless people does it address? 

• 	 How was the approach implemented? What challenges were encountered? What 


opportunities were used? 


• 	 How is the approach administered and coordinated? What is the role of each stakeholder? 

• 	 How is the approach funded? Do requirements of the funding sources create any barriers 

or promote any successes? 

• 	 Did implementation include efforts to reduce local resistance by including community 

members? How? How successful have these efforts been? 

• 	 Can the community document its progress; either by showing that the numbers of street 

homeless people have decreased or by showing that programs are accepting this 

population and helping them leave homelessness? 

• 	 How else do communities use data to bolster their case for makillg the investment to end 

chronic street homelessness? 

Who, What, Where, and When 

In 2002, HUD contracted with Walter R. McDonald Associates, Inc. and its subcontractor, the 

Urban Institute, to conduct a study to answer the research questions. HUD asked us to fmd 

community-wide approaches to reducing chronic street homelessness, to the extent possible, 

because its analysts suspected that such a focused commitment might be necessary for 

substantial progress. 

We sought communities appropriate for site visits through recommendations of key informants 

and a literature search for evaluated projects, identifying over 120 possible programs and 

communities. Screening phone calls to community and program representatives helped us 

identify appropriate communities to visit. Criteria for selection included that the community have 

an approach to ending chronic street homelessness, that it be community-wide, 7 and that there be 

evidence to document that the approach actually succeeded in reducing chronic street 

homelessness. (The selection methods are described further in Appendix H.) 

7 For our purposes, "community-wide" means that a jurisdiction such as a city or a county has an effective crossagency collaborative approach. See Chapter 2 for a fuller discussion oftbis term. 

3 
Chapter I: Introduction 

We were able to find three communities that met all three criteria, and several others that met the 

criteria but only for specific subpopulations such as veterans, people with severe mental illness, 

or people with co-occurring disorders. We also visited four communities that did not meet all 

criteria. We reasoned that many communities throughout the country would benefit from 

knowing what could be accomplished even without a community-wide approach, as not all 

communities will be able to begin with community-wide commitment. The seven communities 

visited were: 

• 	 Binningham, Alabama; 

• 	 Boston, Massachusetts; 

• 	 Columbus, Ohio; 

• 	 Three projects in Los Angeles, Califorrua--one focused on homeless veterans, one 

focused on mentally ill offenders in the county jail system, and one focused on chronic 

street homeless people in the downtown "Skid Row" area; 

• 	 Philadelphia, Pennsylvania; 

• 	 San Diego, California; and 

• 	 Seattle, Washington. 

We conducted site visits to each of these communities, ranging in length from 2 to 5 days 

depending on the complexity of the community's approach and the components we chose as the 

focus of our visits. We interviewed between 40 and 90 people per site, including focus groups at 

each site of 5 to 10 formerly street homeless people. Representatives at each site had the 

opportunity to review for accuracy our description of their community and its activities for 

ending chronic street homelessness. Below we present a short introductory sketch of our sites in 

alphabetical order. The complete descriptions are in Appendices A through G. 

Birmingham, Alabama 

Metropolitan Birmingham Services for the Homeless, the entity orchestrating most of the 

homeless network planning and development that occurs in Birmingham, is a membership 

organization with no formal authority or control over its members. The network of programs and 

services developed to encourage people to move from the streets into housing includes outreach, 

emergency shelter, and transitional and permanent supportive housing. A safe haven8

is just being 

developed, with an anticipated opening date of December 2003. Employment and community 

8 Safe havens are very low cost or free housing programs for homeless persons who, at the time, are unwilling or 

unable to participate in mental health treatment programs or other supportive services. Safe havens provide low 

demand housing with no limits on length of stay. The Stewart B. McKinney Homeless Assistance Act, as amended 

in 1992 by Public Law 102-550, authorized the Secretary of the Department of Housing and Urban Development 

(HUD) to make grants for such housing, but not all the programs we refer to receive these grants. 

4 

Chapter 1: Introduction 

service are important emphases in programs working with people whose homelessness is 

cOInplicated by chronic substance abuse. Birmingham has been the site of an ongoing research 

project funded by the National Institute on Drug Abuse that has had considerable success in 

treating homeless addicts. Agencies have deyeloped some innovative ways to blend the interests 

of property owners and poor people to create affordable housing with very little government 

funding, and have involved the business community in other ways to address street 

homelessness. 

Boston, Massachusetts 

Boston has mayoral-level community-wide planning and program development, extensive 

involvement of mainstream agencies and funding from state and local general revenues, and an 

extensive and committed community of service providers and advocates working with homeless 

people. Through a collaborative network of programs and services, the city moves several 

thousand individuals out of homelessness each year through services such as street outreach and 

drop-in centers, emergency shelter, substance abuse and mental health treatment, medical 

services, educational programs, career development and employment services, transportation, 

and transitional and permanent housing programs. The city has a highly developed approach to 

discharge planning and homelessness prevention for people with severe mental illness, and is 

very focused on affordable housing production and preservation. 

Columbus, Ohio 

The lead agency for the homeless service system in Columbus is the Community Shelter Board 

(CSB), an independent nonprofit agency founded in 1986 by a group of civic leaders, business 

associations, local government leaders, and representatives from a variety of foundations. CSB 

does not provide any direct services within the community, nor is it an original source of money 

for homeless assistance services. Its main responsibilities are resource development and 

investment, service delivery coordination and planning, program accountability, and systems 

change and public policy reform. The Community Shelter Board currently allocates $7.5 million 

annually to 14 partner agencies for programs serving homeless individuals and families in 

Columbus. 

The community's main strategy for ending chronic homelessness is embodied in an initiative 

known as "Rebuilding Lives." It is a community-based initiative developed by the Scioto 

Peninsula Task Force in response to problems created by downtown redevelopment along the 

part of the riverfront known as the Scioto Peninsula. The task force was charged with developing 

a coordinated, targeted, cost-effective method of providing shelter and services to homeless 

individuals and families. Launched in July 1999, the Rebuilding Lives initiative focuses on 

ending homelessness and "rebuilding lives" by meeting the short-term needs of homeless 

individuals through an improved safety net of emergency shelters and by establishing 800 units 

of permanent supportive housing programs for homeless individuals with long-term needs. It 

includes opportunities for people with severe mental illness, addictions, HIV/AIDS, and 

combinations to leave the streets for permanent housing with supports in a "housing first" 

approach that can be as short as three weeks from first contact on the streets to lease signing. 

5 

Chapter 1: Introduction 

Los Angeles, California 

Unlike the other cities we visited, Los Angeles does not offer a single coordinated system for 

reducing chronic street homelessness, although the Los Angeles Homeless Services Authority 

(LAHSA) provides funding and guidance for local nonprofit agencies with programs that address 

homelessness and coordinates the county's Continuum-of-Care applications, in which most of 

the county's 88 entitlement jurisdictions participate. What Los Angeles does offer, because of its 

immense size, are -several specialized continuums to meet the needs of frequently underserved 

subgroups of homeless individuals. We visited three such networks that have been working 

diligently to end chronic street homelessness-the Veterans Affairs Greater Los Angeles 

Healthcare System (V AGLAHS), Lamp Community, and a state-funded program known as AB 

2034 after its legislative bill number. AB 2034 offers integrated services to mentally ill homeless 

people, and is administered in Los Angeles by the Los Angeles County Department of Mental 

Health (LAC-DWl). The Department of Veterans Affairs and Lamp Community both offer 

comprehensive services for homeless individuals, while the AB 2034 program is primarily a 

funding and coordinating mechanism for service delivery to prevent homelessness upon release 

for mentally ill offenders in the county jail population. Although these programs do not all work 

in concert with each other, there is significant overlap among the systems. For example, Lamp 

Community is a funded program under AB 2034 and at least one VA partner agency collaborates 

with Lamp Community to provide housing for Lamp guests. Another organization, Shelter 

Partnership, collaborates with both the AB 2034 program and Lamp Community by providing 

technical assistance in many areas including housing development, funding, and grant writing. 

Shelter Partnership also touches many agencies through its advocacy for homeless individuals 

and its shelter resource bank, which provides surplus merchandise to homeless agencies. 

Philadelphia, Pennsylvania 

Mayor Wilson Goode in 1988 created the Office of Services for the Homeless and Adults. The 

office director eventually became a "homeless czar," a position that the next two mayors have 

maintained and expanded. The current "czar's" official designation is the Deputy Managing 

Director for Special Needs Housing. Having someone in this position means there is a single 

person whose obvious job it is to resolve issues about homeless services. This is the Mayor's 

point person on homeless issues, held responsible for emergency shelter directly but also 

expected to interact with mainstream systems and coordinate activities more broadly to address 

homelessness. Through this office and in partnership with a strong array of providers, advocates, 

and businesses, the city has planned for and subsequently undertaken extensive investment in 

programs and services to end homelessness. 

A major focus of Philadelphia's efforts has been people experiencing chronic street 

homelessness. The network of programs and services developed to encourage people to move 

from the streets into housing includes extensive outreach, entry-level safe havens and other low 

demand residences, emergency shelters, transitional housing programs, permanent supportive 

housing programs of various configurations, and supportive services purchased or supplied 

directly by city agencies. These latter services include outreach, mental health and substance 

abuse treatment and intensive case management, and primary health care. Community 

development corporations (CDCs), including several created and run by homeless assistance 

6 

Chapter 1: Introduction 

providers, have been active in creating affordable housing that may be occupied by formerly 

homeless and other persons. 

San Diego, California 

The Ad Hoc Committee on Downtown Homelessness is San Diego's lead entity for planning and 

developing resources to end street homelessness in the downtown area. Important differences 

about San Diego's approach from the community-wide approaches in Philadelphia and 

Columbus include the informal nature of its lead entity, extensive involvement of the downtown 

redevelopment agency, Centre City Development Corporation, the Downtown San Diego 

Partnership, and local law enforcement and the courts in addressing street homelessness, along 

with the more expected city and county agencies. San Diego's downtown area has undergone 

redevelopment in recent years, adding a convention center, considerable waterfront development, 

office buildings, and both market rate and affordable housing. With development of each major 

downtown section, the homeless street people who frequented the area found themselves 

displaced. As downtown revitalized, the issue of street homelessness became a focus of 

discussion. Two police department programs to address street homelessness were already under 

way when the decision was taken to build a new major league ballpark downtown, in an area that 

had become the most recent center of street homelessness. The impending ballpark development 

galvanized San Diego businesses and government agencies to get serious about reducing street 

homelessness in a responsible way. The network of programs and services developed to 

encourage people to move from the streets into housing includes outreach, much of which is 

linked to multi-agency team community policing strategies, emergency shelter, safe havens, and 

transitional and permanent supportive housing. 

Seattle, Washington 

Seattle does not have one authority responsible for community-wide strategies to address chronic 

homelessness. Yet over time, the region has developed an approach to this popUlation as 

homeless service providers, low-income housing providers, and other agencies involved with 

chronic street homeless people have cultivated working relationships and capitalized on Federal 

and local funding opportunities to expand programming. No community-wide coordinating 

entity controls and manages the full spectrum of resources and services targeting chronic 

homelessness. Instead, individual nonprofit service providers and government agencies have 

taken it upon themselves to tackle the problem of chronic street homelessness through 

specialized service offerings. Some of these agencies work together to meet the needs of their 

clients while others operate service structures representing the full continuum of care under their 

own umbrella. Local government leaders-primarily from Seattle and King County-have 

sponsored various coalitions and task forces over the years that have brought these agencies 

together to analyze needs, establish priorities, and plan for specific projects and system 

improvements. Seattle has also responded to Federal funding guidelines concerning 

programming strategy and initiatives to reduce chronic street homelessness. 

7 

Chapter l: Introduction 

Report Organization 

We have tried to make this report accessible and practical in several ways. First, we have 

analyzed the information gathered from the seven communities in cross-cutting chapters that 

give an overview of a particular topic, including: 

• Chapter 2. Elements of Success 

• Chapter 3. New Strategies for Programs and Services 

• Chapter 4: Assembling Resources and Supports 

• Chapter 5. Documenting Progress 

• Chapter 6. How Communities Pay For Their New Approaches 

• Chapter 7. Policy, Practice, and Research Implications 

Second, we present full descriptions (in Appendices A through G) of the seven communities we 

visited and the ways they have approached the job of ending chronic homelessness. These 

chapters are structured similarly, beginning with a brief community overview followed by a 

section recapping three to six practices of potential interest to other jurisdictions, including 

contact information for each practice and a community contact. So readers can go directly to the 

source to fmd out more about practices they might want to examine more closely. Each appendix 

then has sections for the history of the community's approach, a description of that approach, 

documentation of progress, details of selected system components, funding, maintaining and 

enhancing the system, and community relations. 

Third, the report's fmal chapter discusses the implications of the fIndings for policy, practice and 

research concerning approaches to reducing chronic homelessness. 

8 

CHAPTER 2: ELEMENTS-OF SUCCESS 

What Does It Take? 

This chapter introduces the elements that made efforts to reduce chronic street homelessness 

successful in the study communities. The following chapters elaborate on important aspects of 

the elements and their interactions, and end with implications for policy, practice, and research. 

Although we provide examples in the report chapters, the site report appendices provide a more 

complete description of how the elements of success work together in a specific community. 

Introduction 

We identified 11 key elements shared by many of the approaches successfully reducing chronic 

street homelessness. Five of these elements, in combination, are essential for the strongest 

approaches. In addition to these five elements, trigger events were an important catalytic element 

for four.of.our study communities. Five other elements when present contributed t.o making an 

appr.oach stronger. The elements were: 

Essential Elements: 

• A paradigm shift; 

• A clear g.oal .of ending chronic street h.omelessness; 

• C.ommunity-wide level of.organization; 

• Strong leadership and an effective organizational structure; and 

• Significant res.ources fr.om mainstream public agencies. 

Catalyst Element: 

• Trigger event--capacity t.o capitalize .on triggering events. 

Contributing Elements: 

• Significant res.ources fr.om the private sect.or; 

• C.ommitment and supp.ort fr.om elected .officials; 

• Outc.ome evaluati.on mechanisms f.or program support and improvement; 

• Openness to new service approaches; and 

• Strategies to minimize negative neighborhood reactions to projects. 

9 

Chapter 2: Elements of Success 

Paradigm Shift 

Of the five essential elements the most important was a paradigm shift away from traditional 

homeless program goals and approaches. The old paradigm was that street homeless individuals 

should be cared for more by charitable, often religious, organizations rather than by mainstream 

public agencies. The old paradigm relied heavily on emergency shelters, transitional housing, 

and sobriety-based programs. The old paradigm did not plan, or expect, to end chronic street 

homelessness. 

The new paradigm emphasizes reducing and eventually ending chronic street homelessness 

through an integrated community-wide approach that includes substantial participation by 

mainstream public agencies. Part of the paradigm shift was the adoption of an explicit goal to 

end chronic street homelessness. A second part of the shift was communities recognizing that 

their existing homeless assistance network was not reducing homelessness and that they had to 

do something different. Permanent supportive housing programs had to expand, they had to be 

structured to accommodate people with co-occurring disorders, and clear and simple pathways 

from the street into housing had to be available. The general homeless service programs may 

remain, but the new programs, supported with new resources, contribute the most to 

reaching the goal of ending chronic street homelessness. 

The paradigm shift to low-demand permanent supportive housing on a broad scale affects 

policymakers, funders, program planners, and service providers. The new approaches can be 

especially challenging for traditional housing developers and social service providers. For mental 

health and social service providers, low-demand environments mean they cannot require tenants 

to use services, and they have to deal with both mental health and substance abuse issues, and do 

so simultaneously. In addition, tenants may not use their services consistently, thus reducing 

reimbursements on which the providers may rely. For housing providers, a low-demand 

residence means that tenants may not act as predictably as the property managers might wish. 

For both, the challenges are as much philosophical as financial, in that the new model demands 

that they conduct business in ways that had formerly been considered not just impractical but 

wrong (Grieff, Proscio, and Wilkins, 2003). 

A Clear Goal of Ending Chronic Street Homelessness 

The most successful community-wide approaches have an explicit goal of ending chronic street 

homelessness. Two communities, Columbus and Philadelphia, have adopted the goal of ending 

chronic homelessness, which has turned their priorities away from emergency and even 

transitional programs. They invest heavily in permanent supportive housing and have stabilized 

(Columbus) or actually reduced (Philadelphia) the number of emergency shelter beds they 

support as they work to move persistent shelter stayers (Philadelphia) and street homeless people 

(both cities) into permanent supportive housing. Columbus follows a "housing first" model for 

chronic street homeless people, moving them directly from the streets into permanent supportive 

housing, still with low demands. Philadelphia also tries to bypass emergency shelter for street 

homeless people, but has focused more on safe havens as an intermediate step toward permanent 

housing and has only recently begun to develop its frrst "housing frrst" program. 

10 
Chapter 2: Elements of Success 

San Diego has set itself the goal of ending downtown street homelessness, which is a paradigm 

shift from the city's earlier ways of dealing with street homeless people. It bas some unique ways 

of addressing street homelessness among chronic inebriates and those with severe mental illness 

and co-occurring_disorders, thanks to a police department that has long been in the forefront of 

community-oriented and problem-solving policing. San Diego developed several safe havens and 

is working on developing more permanent supportive housing, with active involvement of the 

local redevelopment authority and the business community. 

Strong Community-Wide Level of Organization 

A community-wide level of organization exists when agencies are working together to end 

chronic street homelessness. As we describe organizational approaches, it helps to think about 

three levels of contact or working together for two or more agencies~ommunication, 

coordination, and collaboration (Konrad, 1996; Melaville and Blank, 1991 ).9 These levels are 

hierarchical-agencies cannot coordinate without communicating, and cannot collaborate unless 

they both communicate and coordinate. The hierarchy reflects the extent to which agencies pay 

attention to other agencies, perhaps change their own ways, and make a joint effort to reach 

shared goals. We use these hierarchical terms very carefully throughout this report and defIDe 

them as follows: 

• 	 Communication. Agencies are at the level of communication if they have accurate 

knowledge of each other's existence, service offerings, and eligible clientele. They 

will a1so know how to access each other's services, and may refer clients to each 

other. They may have shared involvements through meetings, committees and task 

forces, but they do not have mechanisms in place to support each other's work. 

• 	 Coordination. Agencies are at the level of coordination if in addition to 

communicating they support each other's efforts to obtain resources for clients. 

However, they do not deliberately work to develop shared goals and structure their 

operations to meet these goals. 

• 	 Collaboration. Agencies are at the level of collaboration if they work with each other 

to articulate shared goals, analyze their operations to determine how they may 

achieve those goals, and make the changes dictated by this analysis. 

Of course agencies may relate to each other below the level of communication-that is, they do 

not know these things about each other, do not interact in any way, interact negatively, and/or 

hold inaccurate views of each other. In most communities at most times, most agencies operate 

toward each other at the level of communication or worse. This is "business as usual"-it takes 

work to get beyond it. 

Collaboration may mean that agency staff members fulfill new roles or restructured roles; colocate, team, or otherwise work together with staff of other agencies; merge money, issue joint 

9 Some may prefer the term "cooperate" to "coordinate." We think they mean the same thing in the context of the 

levels we are describing, and use "coordinate" because it was used in previous work. 

11 
Chapter 2: Elements of Success 

requests for proposals, apply together for new money to do new programs in new ways; actively 

support each others' work; have mutual feedback mechanisms to assure continued appmpriate 

service and program delivery; and/or other mechanisms and activities that reflect a purposeful, 

well-thought-out commitment to work together to reach common goals. Collaboration can occur 

between two agencies, or among several agencies. When it extends to include all or most 

agencies in a conununity focused on the same population with the same goals, we call it a strong 

community-wide level of organization. 

Strong Leadership and an Effective Organizational Structure 

Strong leadership within an effective organizational structure was crucial in the development of 

successful community-wide approaches. 

The Importance ofKey People Exercising Leadership 

Ultimately, it is people and not systems that make things happen--especially in the beginning. 

Individual personality and devotion played an extremely important role in the development of 

the homeless assistance systems we visited. In most of these communities, a few people have 

been such essential players that it would be hard to imagine that without them the system would 

be what it is today. They have not all played the same roles. Some have been idealistic inspirers 

who brought public and private resources to focus on the issue of chronic street homelessness 

and stick with it, although their role in the actual organization of services might have been slight. 

Some have been socially and politically skilled organizational masterminds who knew what it 

would take to get an aggregation of programs and personalities to become a system focused on 

chronic street homelessness. Some have occupied vitally important positions in government 

agencies and persisted over many years in bringing those agencies to the table, keeping them 

there, and seeing that agency resources were applied to homeless issues, including chronic street 

homelessness. And some have been instrumental in bringing about a significant meeting of 

minds because they insist on cooperation and accountability, yet have a high tolerance for 

tension and the ability to channel it toward useful outcomes. It is vital to recognize the role 

played by people who really care, and who have the ability to translate that caring into structures 

of cooperating individuals, programs, and agencies. Without them the homeless assistance 

systems in their communities would look far different. 

We cannot describe the actions and effects of all the leaders in all the communities we visited. 

However, in the Appendices we describe a few leaders and the effects of their leadership, to 

show the range of positions in which communities have found leadership, and the capacity of 

people operating in any position to offer leadership and make a difference. 

Effective Organizational Structure 

The seven communities we visited for this project have very different structures through which 

they have developed assistance networks for chronically street homeless people. Most of the 

communities we visited did not begin their endeavors in the homeless arena with a focus on 

reducing or ending chronic street homelessness. These focused structures evolved, some over 

12 

Chapter 2: Elements of Success 

decades, with varying degrees of local political support and local funds. Consequently, they 

emerged in diverse forms. In Columbus a nonprofit lead agency received strong authority and 

resources from city, county, business, and philanthropic interests some years before the new 

initiative. In Philadelphia a combination of a city agency with authority and resources, a Mayor's 

Task Force, and a voluntary association of all interested parties each play their roles. San Diego 

developed an informal but well organized group of leaders from relevant positions in the city and 

county governments and a downtown business association. 

What these organizational structures had in common were strong links to elected officials and 

mainstream governmental and private sector resources. They were not working only in the 

context of programs for homeless persons. The organizational membership also crossed over 

city, county, and private sector boundaries. While always coordinating with service providers, 

the lead organizations did not always include them as full members. 

Significant Resources from Mainstream Public Agencies 

Ending chronic street homelessness requires resources far beyond those commanded by agencies, 

programs, and networks exclusively focused on working with homeless people. Major 

commitments of resources are needed from mainstream public housing, health, mental health, 

substance abuse, welfare and other agencies. 

Mainstream public agencies have four roles to play with respect to ending chronic homelessness. 

These are facilitating homeless people's access to their services, developing specialty 

approaches, establishing funding priorities, and contributing leadership of various types. 

All of the communities we visited for this study have significant involvement of mainstream 

public agencies; some have major, sustained commitments and participation in leadership to end 

chronic homelessness. Most communities in the nation enjoy considerably less mainstream 

agency involvement, and could benefit from increasing the effectiveness of such partnerships. 

Getting mainstream public agencies to the "homeless" table takes planning, persistence, and 

sometimes power. It also often takes being able to present the case for their involvement as a 

mutually beneficial situation in which mainstream agencies are able to serve "their own" clients 

better by joining forces with the local homeless assistance network. The mainstream agencies 

whose own missions coincide most closely with the goal of ending chronic homelessness, and 

hence the ones that will have the greatest incentive to work with homeless assistance networks 

toward that end, include housing and community/neighborhood/economic development agencies; 

health, mental health, and substance abuse agencies; and to an increasing extent, corrections 

agenCIes. 

Ability to Capitalize on Trigger Events 

In several of the communities we visited, "trigger events" stimulated re-examination of the 

community's approach to chronic street homelessness. The experiences of these communities in 

turning trigger events with potentially disastrous consequences for homeless people into 

13 

Chapter 2: Elements of Success 

opportunities for growth and change provide examples for other communities seeking to develop 

new approaches to chronic street homelessness. 

In two communities the trigger event was proposed development on land that was "home" to 

many homeless people. In Columbus it was prospective redevelopment of the Scioto Peninsula 

along Columbus' riverfront; in San Diego it was the prospect of a new downtown ballpark. In 

two other communities the trigger event was a proposed city ordinance to criminalize street 

homelessness. One city, Philadelphia, actually passed such an ordinance but not before it had 

undergone considerable revision and resources had been appropriated to ameliorate its harshest 

conditions. In the other city, Birmingham, the ordinance was defeated but mobilizing to be sure 

that happened stimulated some significant forward movement in addressing street homelessness. 

Significant Involvement of the Private Sector 

In addition to governmental agencies, we found that private businesses and foundations were 

often mainstream organizations making significant contributions to reducing street homelessness. 

Their involvement is described more fully in Chapter 4 on assembling resources and supports, 

but we note a few examples here. 

Private Businesses 

Many of the communities we visited have been promoting central city redevelopment. In the past 

many downtown businesses and developers have had a kneejerk reaction against providing 

services to their neighborhood's street homeless people, fearing that services would attract more 

homeless individuals. However, in four of our communities, businesses and their associations 

took leadership roles in programs providing services to help end street homelessness. These were 

Birmingham, Columbus, Philadelphia, and San Diego. 

In the late 1990s the Birmingham City Council was considering an ordinance that would have 

banned "urban camping," a measure clearly aimed at street homeless people in the downtown 

area. The proposal galvanized support for an alternative-active outreach programs to bring 

people off the streets without criminalizing them. Advocates of the ordinance complained that 

street homeless people were creating problems such as panhandling, litter, poor sanitation, and 

safety concerns. Advocates for the homeless population wanted to develop a more constructive 

and less punitive approach. The mayor created a Task Force on Homelessness to address the 

issue. As an outgrowth of the Task Force, the City Action Partnership (CAP)-the city's 

Business Improvement District- funded an assistance-oriented uniformed patrol. CAP officers 

provide services downtown that range from directing shoppers to stores to helping case managers 

locate homeless individuals when they need to deliver medications or other services. CAP 

prepares pamphlets listing resources by needs with addresses and maps for food, shelter, 

clothing, and employment services. CAP officers routinely coordinate with outreach workers 

from several programs to facilitate assistance to street homeless people. 

Columbus businesses playa major role in Community Shelter Board (CSB) fundraising and 

strategic planning. Business leaders predominate on the CSB's governing board of trustees and 

have led it to adopt an outcomes-based funding model that has won the respect of agencies and 

14 

Chapter 2: Elements of Success 

the general pUblic. CSB leverages public grants with corporate fund raising, and private dollars 

-make up over 20 percent ofCSB's annual revenue. The private funding helps support innovative 

programs that have brought Co-Iumbus national recognition as a community with creative and 

effective homeless assistance programs. 

Foundations and Nonprofit Organizations 

Organizations such as the United Way, which address a wide range of community needs, have 

the potential to make significant contributions to a community's efforts to end chronic 

homelessness. In Columbus the United Way helps fund supportive housing for Rebuilding Lives. 

In Columbus United Way also supports emergency shelter and other CSB initiatives including 

Rebuilding Lives. The total United Way commitment to the CSB is $1.0 million. In Boston the 

United Way funded $4 million of emergency shelter, transitional housing, and support services; 

cash, and in-kind donations from businesses, religious and civic organizations totaled over $3.6 

million; and over 50 foundations contributed over $7 million. Cash donations from individuals to 

programs were also substantial, totaling an additional $12.5 million. 

Commitment and Support from Elected Officials 

Commitment and support from mayors, city and county councils, and other elected officials can 

be a significant contributing element in the progress of community-wide efforts toward reducing 

chronic homelessness. In at least three of our sites, mainstream city officials and business leaders 

played a seminal role in initiating collaborative programs to end homelessness. Philadelphia's 

Mayor Goode created an Office of Services for the Homeless and Adults and appointed a de 

facto "czar" of homeless assistance programs who orchestrated planning and implementing a 

wide set of services; subsequent mayors maintained and expanded these efforts. Boston's Mayor 

Menino placed ending homelessness high on his agenda, created a homeless planning committee 

and pressed mainstream city agencies to become involved. In San Diego mainstream business 

leaders and city officials involved in mitigating the potential displacement of street homeless 

persons expected from the construction of a new baseball stadium were among the founders of 

the interagency Ad Hoc Committee on Downtown Homelessness, which is developing solutions 

involving housing and services for the special needs homeless population. 

State and national political environments also have a significant impact on community 

approaches to reducing chronic street homelessness. This may be especially true at the state 

level, which requires a wider mobilization of support than city or county initiatives. Many state 

assemblies and governors would not follow the examples of California and Massachusetts in 

making large fiscal commitments to programs to end homelessness. Winning support from 

elected officials for state and other mainstream funding of programs to end homelessness is 

greatly facilitated by demonstrations of positive outcomes and cost effectiveness. The potential 

savings from innovative programs may be demonstrated by developing good estimates of how 

much homeless persons are costing the public through conventional emergency services and law 

enforcement programs. 

15 

Chapter 2: Elements of Success 

Outcome Evaluation Mechanisms for Program Support and Improvement 

Agencies and planners in the communities we visited use data to demonstrate that programs are 

operating as designed and having successful impacts. The primary types of data we found to 

document progress in ending chronic street homelessness were: 

• 	 Changes in the number of people found on the streets from year to year; 

• 	 Increases in the number and percentage of chronically street homeless people who 

have moved into permanent housing; 

• 	 Reductions in costs of providing emergency health, mental health, and shelter 

servIces; 

• 	 Reductions in days homeless, hospitalized, or incarcerated; and 

• 	 Less recidivism in the homeless assistance system, as documented by street counts, 

program operations and outcome data, and interagency homeless management 

information system (HMIS) data. 

Some street counts were greatly enhanced by asking the homeless individuals background 

questions. We found examples of communities maintaining information on services provided to 

individuals in linked emergency shelter and outreach databases, which help in monitoring 

program activity, evaluating impacts, assessing needs, and planning programs. Some 

communities also used information systems to demonstrate the incurred costs of providing 

mainstream emergency services to chronic street homeless individuals-money that could be 

saved by effective programs to end homelessness. Good administrative record information on 

homeless-related program operations and outcomes also provide support for program planning, 

policy design, and system development. In addition, a good homeless management information 

system can facilitate case management by providing workers access to better case history 

information and knowledge of what other programs may be serving the client. Finally, some 

agencies and communities are using analyses based on sound data to support community 

relations and program advocacy work. 

Openness to New Service Approaches 

Contributing to the progress of the study communities was their openness to new service 

approaches. Ending chronic street homelessness requires new approaches to homeless service 

delivery. It requires new ways of helping people (such as harm reduction), new ways of 

providing old services (such as housing first), new agency relationships (such as joint provision 

of mental health and substance abuse services, or agency mergers), and new investments in 

effective approaches (such as permanent supportive housing). It can also involve redesigning 

service systems to create better matches between people's needs and the services they receive. 

One such shift involves reserving emergency shelter and other forms of short-term assistance for 

those with acute needs who are homeless for the fIrst time or as the result of a crisis, while those 

with chronic needs receive longer-term supports (including effective treatment for co-occurring 

mental illness and substance abuse) and permanent housing. (Columbus and Philadelphia are 

16 

Chapter 2: Elements of Success 

using this strategy.) Reducing chronic street homeless ness also results from effective outreach 

and engagement strategies, especially those that are able. to link people directly to housing. 

Finally, new approaches to prevention can prevent people with chronic disabilities from 

becoming homeless in the fIrst place. 

Strategies to Minimize Negative Neighborhood Reactions to Locating Projects 

Frequently, some neighborhood residents resist locating projects for homeless persons in their 

neighborhood-the "not in my backyard" (NIMBY) reaction. Communities can minimize 

NIMBY by establishing standards that include looking for favorable locations, planning 

appropriate structures and activities, and involving the neighborhood in planning. However, the 

success of these mitigating activities is affected by economic, cultural, and political factors 

beyond the control of programs. Planning and opening new sites are especially volatile activities 

that require agencies to establish good communication with neighbors and work to mitigate 

potential adverse effects. Public meetings with frank descriptions of the project, testimony by 

neighbors of similar projects, and opportunities for people to express their concerns are essential. 

(Columbus, Philadelphia, and Seattle employ the strategy of using testimony by people who had 

seen past projects start up in their neighborhoods.) Forming advisory committees with neighbor 

representation that address how to resolve problems is also crucial. A good practice is to select 

locations where rezoning is not necessary and where facilities can be built that improve the 

neighborhood by removing eyesores and trouble spots. Our sites were able to implement this 

practice without concentrating their projects in the lowest income areas. 

Communities should also have policies that ensure programs are good neighbors once a facility 

opens. Good neighbor agreements can help promote community relations in the areas of property 

maintenance, neighborhood codes of conduct, community safety, communication and 

information, and agreement monitoring and compliance. Agencies can foster better community 

relations through open houses, making meeting rooms available to neighborhood organizations, 

participating in neighborhood watch projects and involving the public in flx up and fund raising 

activities. Staff members can educate neighbors on ways of interacting with homeless individuals 

and ways of addressing issues they create as a group. 

Homeless and formerly homeless individuals can be effective spokespersons to call public 

attention to their concerns and help develop programs to remedy their problems. These 

individuals can personalize and associate a human face· with the issues by speaking at public 

meetings. 

Conclusions 

This chapter focused on the elements of success separately to provide a clear portrayal of each, 

however, the combined effects of the elements are what power the greatest community progress 

toward the goal of ending chronic street homelessness. Of particular importance is the paradigm 

shift toward a community-wide focus on eliminating chronic street homelessness through 

mainstream public agency programs including permanent supportive housing. 

17 
Chapter 2: Elements of Success 

As we repeatedly stress, this is an experimental time for programs to reduce homelessness, new 

approaches are being tried and the evaluations of their success are still in emergent stages. 

Nevertheless, our analyses of the seven study sites, as well as information gathered about other 

locations during the site selection process, suggest that-certain elements are essential for a 

community to make significant progress toward the goal of ending homelessness. The essential 

elements were: the paradigm shift; a clear goal of ending chronic street homelessness; 

community-wide level of organization; strong leadership and an effective organizational 

structure; and significant resources from mainstream public agencies. At most of our sites, 

catalytic trigger events combined with a capacity to capitalize on the event led to significant 

improvements in the community's approach. 

We also found the foHowing elements contributed to making a community's approach more 

effective: significant resources from the private sector; commitment and support from elected 

officials; outcome evaluation mechanisms for program support and improvement; openness to 

new service approaches; and strategies to minimize negative neighborhood reactions to projects. 

Our list of elements emerged and changed over the course of the study, and we do not view it as 

exhaustive and immutable. It is a snapshot of what we saw happening at this time. The next 

chapter of the report presents some specific strategies that the communities were incorporating 

into their approaches for reducing chronic homelessness. 

18 

CHAPTER 3: NEW STRATEGIES FOR PROGRAMS AND SERVICES 

The number and variety of homeless assistance programs has grown tremendously since the late 

1980s and early 1990s, becoming a $2 billion a year endeavor today (National Alliance to End 

Homelessness, 2000). Yet chronic homelessness remains a serious problem in many 

communities across the country, despite the system that has been developed to date. As 

communities come to recognizeJ:his reality, they may abandon their old paradigms of what 

works and shift to new approaches. We described in Chapter 2 how some communities have 

made this paradigm shift in terms of their general goals and methods. In this chapter we discuss 

more specifically some successful strategies for reducing chronic homelessness. 

Looking at the characteristics of most chronically homeless people, it is obvious that most have 

serious mental illnesses, substance abuse disorders, HIV / AIDS, or physical disabilities. Many 

have more than one of these major problems, anyone of which frequently results in their being 

twned away from many traditional homeless assistance programs. Fw1:her, they have been 

homeless a long time, often have no ties to family, and rarely have any resources. Their skills are 

oriented toward survival on the streets, not to living in housing. 

Any effort that expects to reduce chronic homelessness to any significant degree must attract and 

hold the target population-something that traditional approaches have often failed to do, or the 

people would not still be homeless. First and foremost, there have to be effective ways to contact 

and recruit chronically homeless people into programs. Equally important, there must be 

something to offer them that they will take-the programs need to fit the people, rather than the 

reverse. 

Outreach, housing, and supportive services are obvious components of a solution, but as existing 

versions of these elements are not doing the job, or not all of the job, new versions have had to 

be developed. Preventive efforts are also increasingly part of the picture, in the form of planning 

and providing housing and supports for people at high risk of homelessness on being discharged 

from institutions. More and more communities have recognized that their outreach, housing, 

supportive services, and discharge planning must incorporate the following abilities if they are 

going to be part of the solution to chronic homelessness: 

• 	 The ability to attract people with addictions. Many chronically homeless people are 

initially unwilling to commit to sobriety. If programs cannot work with people who are 

still using alcohol and drugs, they cannot attract the hard-core street homeless people. 

• 	 The ability to attract people with serious mental illnesses. Many chronically homeless 

people have serious mental illnesses that have affected their willingness to use shelters. 

They often fmd shelters intolerable because of overcrowding, or feel vulnerable and 

threatened by fellow residents, or the shelters themselves will not serve them because 

their symptoms are too disruptive. 

• 	 The willingness and ability to accept and work with people with co-occurring disorders. 

Too many chronically homeless people have been caught in the demands of single-focus 

19 

Chapter 3: New Strategies for Programs and Services 

agencies, within both homeless-specific and mainstream systems. Many agencies will not 

work with people's mental illness until they stop using substances, or will not work with 

their substance abuse until their psychiatric symptoms are under control. 

At the same time communities have been seeing the advantages of interagency databases, multiagency teams, multi-purpose service centers, and processes to increase access to mainstream 

agencies. In this chapter, we examine the ways that programs and services can reduce chronic 

homelessness by accommodating to the needs of the people they want to reach. 

Outreach 

Outreach and engagement are the first steps involved in connecting with street homeless people, 

bringing them off the streets, and linking them with other portions of the service system. Most 

chronically homeless people are unlikely to connect with even the best housing programs unless 

these first contacts are effective. Our study communities provide several examples of new 

strategies to make outreach more effective. 

Philadelphia's Outreach Coordination Center 

Philadelphia's Outreach Coordination Center (OCC) developed in 1998 as part of the city' s 

commitment to develop systematic approaches to ending street homelessness following 

enactment of a Sidewalk Behavior Ordinance. Its innovative aspects include outreach teams from 

several agencies working together and coordinated through a single entity, the OCC; daytime 

rather than nighttime outreach; direct access to safe havens and other low demand residences that 

were developed simultaneously; full cooperation and backup from city health, mental health, and 

substance abuse agencies; and a comprehensive database. The OCC also operates in an 

environment with existing and increasing permanent supportive housing resources. 

The OCC offers a coordinated point of contact for street homeless people. Outreach workers 

linked to the OCC are able to offer a wide array of services. Even more important, at a meeting 

of 17 outreach workers, all said they felt confident that the people they contact will receive the 

services if they are willing to accept them. One does not always find such confidence among 

outreach workers in other cities, as the services often are not sufficient to meet demand, or not 

geared to street homeless people. 

The OCC coordinates most of the city's outreach efforts, including a 24-hour homeless hotline, 

one comprehensive response team, two mental health specialty teams, two substance abuse 

specialty teams (one peer and one professional), and emergency backup from city agencies. The 

teams cover center city and west and southwest Philadelphia, where the majority of chronically 

homeless individuals who avoid shelters are found. In addition to these regular street "beats," 

OCC outreach workers respond to hotline calls from businesses, civic and neighborhood 

associations, and private citizens about homeless people in need. OCC has a case management 

component and access to the city's list of available shelter beds. Representatives of all outreach 

teams meet monthly to review activities and needs. Through radio contact with teams, the OCC 

facilitates resolution of the immediate needs of any homeless person in contact with an outreach 

worker on the street that the worker cannot handle independently. OCC workers have also 

20 

Chapter 3: New Strategies for Programs and Services 

conducted street counts of homeless people every quarter since 1998, and are now doing it 

monthly. 

Since its inception, OCC has maintained a database of all persons contacted by the participating 

outreach teams, averaging about 2,000 unduplicated individuals annually. OCC teams repeatedly 

see about one-fourth of those they contact over a span of years. These are the chronic street 

homeless people the teams try hardest to induce off the streets. The database provides a history 

of their service receipt and an excellent picture of who they are and what their needs are. 

Through common identifiers, the OCC database can be linked with the city's database that 

chronicles most emergency shelter and some transitional housing stays. Using this link, OCC 

workers can see whether any of their consumers have used shelter, and how much. Conversely, 

the city's analysts can assess the proportion of people making heavy use of emergency shelter 

who are also well known to outreach workers. 

San Diego's Police-Based Outreach Teams 

San Diego city has two innovative outreach programs developed by and located in the San Diego 

Police Department-the Homeless Outreach Team (HOT) and the Serial Inebriate Program 

(SIP). Both can offer housing options that bypass emergency shelter, connecting street homeless 

people directly to safe havens, transitional housing programs, or residential treatment settings. 

HOT combines a police officer, a mental health worker, and a benefits eligibility technician in 

outreach teams operating during the day and evening hours to engage mentally ill street people 

and connect them to services. It also has access to "dedicated" safe haven beds to which it can 

bring people if they are willing to leave the streets. The team approaches people on the street or 

at homeless services. Each HOT team member's skills and agency affiliation enhances those of 

the others, to make the combination more effective than anyone or two acting without the others. 

Because they combine police and mental health expertise and authority, they are the only 

outreach teams on the streets that have the ability to remove people either voluntarily or 

involuntarily, in addition to building rapport and making referrals. The mental health worker 

opens up options for care that the police officer could not access, the police officer adds an 

element of protection and authority that the mental health worker could not command, and the 

eligibility technician offers connection to or reinstatement of benefits that serves as a positive 

inducement for street people to accept services. HOT focuses on people who are likely to have 

mental illness as a primary problem and are not likely to get arrested. HOT gets them into 

treatment facilities, safe havens, board and care facilities, and skilled nursing facilities, 

depending on their level and type of need. When HOT encounters alcoholics or other substance 

abusers it offers rehabilitation and help getting into appropriate care for those who are interested. 

SIP comes into play for chronic inebriates who do not voluntarily accept treatment. SIP is a 

collaboration of four city and five county agencies, including law enforcement, the city 

attorney's office, the public defender, the Superior Court, health care, and homeless agencies 

working as a team in a court context. Mental Health System, Inc. is contracted to coordinate the 

program. SIP follows the Drug Court model in offering addicts a choice ofjailor treatment, after 

assuring that the community was willing to pay for treatment if requested. SIP's focus is on 

chronic alcoholics who populate the downtown streets of San Diego. Police officers arrest 

21 

Chapter 3: New Strategies for Programs and Services 

chronic street alcoholics for public drunkenness, and bring them to jail and subsequently to court. 

Once arraigned, caseworkers approach each person, conduct assessments, and offer treatment 

plus transitional housing as an alternative to six months in jail (the maximum allowed under 

California state law) to those who pass the assessment. Many people eventually accept the offer, 

although they may fIrst serve a full jail sentence or even two before they are convinced to try. 

The court monitors treatment compliance; leaving treatment means returning to jail. This 

approach is "something different" for this population, for which the revolving door of arrest and 

detoxifIcation was not working. The approach is also designed to reduce the impact of public 

drunkenness on the community. 

Other Outreach Efforts with Direct Housing Connections 

In Los Angeles we also found innovative outreach efforts focused on well-defmed 

subpopulations of chronically homeless people-veterans, and mentally ill criminal offenders. 

Both efforts were part of larger programs that included housing and supportive services as well 

as health, mental health, and other types of care. Their involvement in a collaborative network of 

public and private agencies and their connection to housing should make them interesting to 

other communities. 

The Veterans Affairs Greater Los Angeles Healthcare System has used Health Care for 

Homeless Veterans programs to conduct outreach to severely mentally ill veterans to link them 

with V A clinical services, contracted residential treatment programs, and contracted transitional 

or permanent supported housing programs. The V A operates some of these programs on its own 

campus, and has developed an elaborate system of contracts with nonprofIt agencies to supply a 

variety of housing and service options. Also in Los Angeles, the County Sheriffs and Mental 

Health Departments and nonprofIt mental health providers collaborate in a partially state-funded 

program to prevent first or repeat homelessness among inmates of the county jail who have a 

serious mental illness. The program begins with integrated outreach focused on individuals who 

are homeless, at risk of homeless ness or incarceration, and who have a serious mental illness. 

In Seattle, the Downtown Emergency Service Center (DESC) operates many programs and 

services that make it a mini-continuum in its own right, all focused on street homeless people. 

One of its programs is outreach, which is able to connect street homeless people to the various 

DESC offerings including transitional and permanent supportive housing. DESC's Homeless, 

Outreach, Stabilization, and Transition Project (HOST) has Outreach and Engagement 

Specialists who work within specifIc geographic regions or in other targeted programs or 

facilities such as drop-in centers for women, local hospitals, and jails to fInd chronically street 

homeless people and help them connect to services and housing. Sometimes they approach 

potential clients directly and other times they develop an engagement plan with staff members 

from other agencies who have had interactions with the person. HOST staff members receive 

referrals from concerned citizens, jail, the Department of Social and Health Services, the mental 

health court, hospitals, the Harborview Medical Center Crisis Triage Unit, the Seattle Public 

Library, family members, and other mental health professionals, shelters, and drop-in centers. 

22 

Chapter 3: New Strategies for Programs and Services 

Other Outreach Efforts Without Direct Housing Connections 

Every community we visited has outreach and engagement programs that are less fortunate than 

those already mentioned, in that they have no direct access to housing options for the street 

people they contact. However successful the outreach to people living on the streets, its value is 

limited in terms of ending chronic street homelessness if the community does not have adequate 

permanent supportive housing or safe haven resources. Large congregate emergency shelters are 

unlikely to succeed in breaking the cycle of chronic street homelessness among people with 

multiple disabilities. Traditional shelters also tend to be places where chronically homeless street 

people are not willing to go and stay for extended periods of time. During a focus group 

discussion of formerly chronically homeless men who were housed in various PSH programs, the 

group was asked what they would do in the absence of the program. Interestingly, several 

commented that they would never want to go back to a shelter-they were more willing to return 

to the streets than to a shelter. 

Nevertheless, many outreach programs are able to help street homeless people in a variety of 

ways even when they are not able to offer them a home. In addition to providing a regular 

contact and a reliable friend on the street, they are able to ease the difficulties of street living. We 

describe one such program here, of several we encountered during site visits-Seattle's Mental 

Health Chaplaincy. 

The Mental Health Chaplaincy provides an outreach and engagement program for the most 

difficult and most vulnerable mentally ill street homeless people. Its outreach strategy involves 

long-term engagement with clients until they receive benefits and are comfortable entering into 

service or housing programs. The Chaplaincy program helped to develop and uses the Relational 

Outreach and Engagement Model currently promulgated by the National Health Care for the 

Homeless Council. 10 This model has four phases to working with homeless individuals: 

approach, companionship, partnership, and mutuality, which revolve around building and 

shaping a relationship with the client. The focus is to build trust with street people until they are 

ready to access services on their own terms. The Mental Health Chaplaincy typically will link its 

clients to other Seattle service providers such as Harborview Mental Health, local emergency 

rooms, the Downtown Emergency Service Center, and the Health Care for the Homeless 

Network. 

New Approaches to Permanent Supportive Housing 

The ultimate solution for ending homelessness of any type is housing. For chronically homeless 

people with disabilities, though, simple housing is not enough. Most people who have been 

living on the streets for many years have mUltiple barriers to independent living and are likely to 

need various treatment and support services for many years. A major innovative step in reducing 

chronic homelessness among people with disabilities was taken in the early 1990s (and even 

earlier in some places such as Philadelphia), when models of permanent housing with attached 

supportive services were developed. Demonstration studies sponsored by NIMH (Shem et al., 

1997) showed that permanent supportive housing (PSH) was very successful at stabilizing its 

10 The curriculum can be found at: http://www.nhchc.org. 

23 
Chapter 3: New Strategies for Programs and Services 

tenants in housing, with retention rates at about 85 percent after two years or more. As PSH 

programs evolved, they embodied most or all of a set of principles since articulated by the 

Technical Assistance Collaborative as: II 

• 	 The housing is affordable for people with SSI level incomes (residents usually pay 30 

percent of income or about $160 per month); 

• 	 There is choice and control over living environment; 

• 	 The housing must be permanent (tenant/landlord laws apply, but refusal to participate in 

services is not grounds for eviction); 

• 	 The housing is "unbundled" from but linked to services; 

• 	 The supports are flexible and individualized: not deftned by a "program"; and 

• 	 There is integration of services, personal control, accessibility, and autonomy. 

Although it is not a principle, in the past a characteristic of many PSH programs has been that 

prospective tenants had to be "housing ready." This almost always meant "clean and sober," 

stabilized on medications if mental illness was an issue, and familiar with the rudiments of 

housekeeping. As a consequence, very few people entered these programs directly from the 

streets. The usual routes could be long, through emergency shelter and transitional housing 

programs. Another consequence is that as of 2002, a surprisingly small proportion of PSH units 

appear to be occupied by people that we would consider to have been chronically homelessonly about 20 percent, according to a recent Corporation for Supportive Housing estimate. 12 

Thus, although some chronically homeless disabled people are being served in the PSH programs 

developed during the past decade, the people on whom this project focuses are, by deftnition, 

those for whom traditional programs and services have not produced solutions to homeless ness. 

One group in particular, people with co-occuning mental illness and substance abuse, has 

traditionally been seen as "resistant to treatment." They have been beyond the reach of many 

traditional homeless service providers, in part because they are "difficult" but also in part 

because providers have not been interested in trying to serve them, having enough easier people 

to serve. But as they comprise a significant share of street homeless people, communities 

committed to reducing street homelessness had to fmd ways to serve them. Their resistance even 

to PSH as it was being offered, and also the resistance of many providers to serving them, has 

challenged communities to develop permanent supportive housing operating on some new, or 

additional, principles. In the communities we visited, these include: 

• 	 Housing ftrst models that place people directly from the streets into permanent housing 

units with appropriate supportive services; 

II These are drawn from "Affordable and Accessible Housing: A National Perspective," presentation by Emily 

Cooper, Technical Assistance CoUaborative, Inc. to the Regional Housing Forum, November 13,2002. 

12 Wilkins, Carol. Presentation at Ending Long-Term Homelessness: Taking Supportive Housing to Scale 

conference, Columbus, Ohio, May 13-15,2002. 

24 
Chapter 3: New Strategies for Programs and Services 

• 	 Safe havens, a variation of Housing First that offers "as long as you need it" 


accommodation but that nevertheless is not intended to be permanent; 


• 	 Low demand-breaking the linkage between housing and service use or acceptance; and 

• 	 Harm reduction or "abstinence encouraged" approaches to sobriety. 

Housing First Models 

Housing First models place people directly from the streets into permanent housing units with 

appropriate supportive services, with no requirement that they be "housing ready." The sole 

requirements are those that are usually expected of any renter-pay the rent, do not destroy the 

property, and refrain from violence. Housing is provided immediately, with few, if any, demands 

with respect to abstinence or accepting mental health treatment or other types of care, although 

these are offered and available. As one advocate for PSH and Housing First puts it, "we give 

them a key to their own door; they don't have to leave it open, but we knock often." Proponents 

of this approach argue that it is much easier to work on substance abuse and mental health issues 

when clients are stably housed than when they are on the streets or in a shelter. More and more 

communities are attempting to offer chronically homeless street people Housing First. Among 

the communities we visited, Columbus, San Diego, Seattle, and two of the Los Angeles sites 

offer Housing First programs, and Philadelphia is just starting to do so. Also, a growing body of 

research documents the success of Housing First models at keeping even the most disabled 

homeless people housed, and also saves some public costs for crisis emergency services 

(Anderson et al; 2000; Culhane, Metraux and Hadley, 2002; Martinez and Burt, 2003; Tsemberis 

and Eisenberg, 2000). 

Housing First programs are very popular among outreach workers, case managers, and their 

clients. Those we interviewed as part of this study reported that they could easily fill their 

permanent supportive housing programs with chronic street homeless people, and the tenants in 

such programs are very positive about them. Of course, slots in permanent housing programs are 

not always available. In Columbus, Ohio, recruitment for these programs tends to happen when a 

program fIrst opens for occupancy. Turnover among tenants has been much lower than expected, 

so the most common way in is at start-up. Also in San Diego, efforts to recruit chronically 

homeless people directly from the streets into PSH (or safe havens when no PSH unit is 

immediately available) are ongoing and successful. 

Safe Havens 

"Safe haven" is a term used by HUD and others to describe a special type of housing program for 

chronically homeless people with serious mental illness, often with co-occurring substance 

abuse. A safe haven program usually takes a Housing First approach, and it may be either 

transitional or permanent housing. Most safe haven programs we talked with will let residents 

stay "as long as it takes" for them to feel comfortable moving on. Data from Philadelphia's four 

safe havens indicate that the average length of stay is 1.3 years, and that most residents move on 

to PSH or to housing in the community, either independently or with family. Three of the 

25 

Chapter 3: New Strategies for Programs and Services 

communities we visited, Philadelphia, San Diego, and Seattle, have safe havens, and 

Birmingham will open one in December 2003. In both Philadelphia and San Diego, capacity and 

turnover appear to be such that a safe haven bed is usually available when a street homeless 

person is ready and willing to take it. Seattle's safe haven is usually full, however, and not able 

to accommodate the many more people on the streets who could and would use this type of 

program. 

Low Demand-Breaking the Linkage Between Housing and Service Acceptance 

A key component of Housing First and safe haven models is their willingness to accept tenants 

without requiring that they participate in services. As already mentioned, the only demand placed 

on tenants in these programs is that they adhere to the conditions of their lease (Housing First), 

or the equivalent without a lease (safe haven). An example of a restrictive condition that remains 

is that projects funded by HUD bar the use of illegal drugs on the premises. Another restriction is 

that some projects require clients to participate in a representative payee program for the purpose 

of assuring that the rent is paid. In many ways, the low demand concept entails significant 

changes that affect policymakers, funders, program planners, and service providers. The new 

approaches can be especially challenging for traditional housing developers and social service 

providers. For mental health and social service providers, low demand environments mean that a 

tenant does not have to use services, or use them consistently. Providers have to attract tenants to 

services, so the services, and the providers, have to be attractive to the very resistant people they 

are trying to serve. In addition, service providers may not be able to count on a predictable level 

of reimbursements for services, upon which their budgets may depend. For housing providers, 

low demand programs may mean that tenants may not always act as predictably as property 

managers might wish, and that housing managers may have to deal directly with tenants rather 

than going through service providers. For both, the challenges are as much philosophical as 

fmancial, because low demand housing sometimes means that they must now conduct business 

in ways that had formerly been considered not just impractical but wrong. 13 Much of the debate 

surrounding Housing First and safe haven models concerns how substance abuse and mental 

health issues are handled, to which we now turn. 

New Approaches to Addressing Substance Abuse 

A central tenet of low demand housing is not requiring sobriety. These sobriety "preferred but 

not required" conditions often translate into a "no use on the premises" rule for projects that use 

HUD funds. The terms "low" or "no" demand housing describe programs where abstinence may 

be encouraged but is not required or enforced. This is one aspect of a more general movement 

known as "harm reduction" within the broader health treatment community of which programs 

for disabled homeless people are a part. 

13 Grieff, Debbie, Tony Proscio, and Carol Wilkins, "What Systems Change Is and Why It Matters to Supportive 

Housing," A preview from an upcoming CSH publication, Corporation for Supportive Housing, January 2003, p. 13. 

Accessed July 7, 2003 online at http://documents.csh.org/documentsiCommunications/SystemsChangePreview.pdf. 

26 

Chapter 3: New Strategies for Programs and Services 

Harm Reduction 

Harm reduction may guide the operations of either permanent or transitional supportive housing. 

Harm reduction is a set of practical strategies designed to reduce the negative consequences of 

drug use by promoting fIrst safer use, then managed use, and fmally abstinence if people can do . 14 It. 

In their position statement on housing options for individuals with serious mental illness, the 

American Association of Community Psychiatrists advocates a full range of community-based 

housing types, including the following: 

• 	 "Abstinence-expected ("dry") housing: This model is most appropriate for individuals 

with substance disorders who choose abstinence, and who want to live in a sober group 

setting to support their achievement of abstinence. Such models may range from typical 

staffed group homes to supported independent group sober living. In all these settings, 

any substance use is a program violation, but consequences are usually focused and 

temporary, rather than "one strike and you're out." 

• 	 Abstinence-encouraged ("damp") housing: This model is most appropriate for 

individuals who recognize their need to limit use and are willing to live in a supported 

setting where uncontrolled use by themselves and others is actively discouraged. 

However, they are not ready or willing to be abstinent. Interventions focus on dangerous 

behavior, rather than substance use per se. Motivational enhancement interventions are 

usually built into program design. 

• 	 Consumer-choice ("wet") housing: This model has had demonstrated effectiveness in 

preventing homelessness among individuals with persistent homeless status and serious 

psychiatric disability (Tsemberis and Eisenberg, 2000). The usual approach is to provide 

independent supported housing with case management (or ACT) wrap-around services, 

focused on housing retention. The consumer can use substances as he chooses (though 

recommended otherwise) except to the extent that use-related behavior specifIcally 

interferes with housing retention. Pre-motivational and motivational interventions are 

incorporated into the overall treatment approach.,,15 

Not surprisingly, the last two options are controversial, and projects that use HUD funds cannot 

perm.it illegal drug use on the premises. Nevertheless, for people with long-term deeply rooted 

problems, these options appear to be among the ones that work best, in part because they are the 

ones that this group of people is willing to try, and in part because the approach to services is one 

they can live with. Participants in focus groups for this project repeatedly stressed the importance 

of having control over their own service uptake, and that staffrespect their right to move at their 

own pace. Harm reduction programs have been the last type of PSH to appear in many 

14 Dra"wn from the Harm Reduction Coalition's website http://www.harmreduction.org/prince.html, accessed July 7, 


2003. 


15 See Kenneth Minkoff, MD, "AACP Position Statement on Housing Options for Individuals with Serious and 


Persistent Mental ILlness (SPMI)," June 18,2001. Accessed on July 7, 2003 at: 


http://www.wpic.pitt.edu/aacp/fmdsIHousing-Revised.pdf. 


27 
Chapter 3: New Strategies for Programs and Services 

communities, and in many areas programs using this approach are not available at all. Yet it has 

great potential for preventing and ending homelessness, especially among people who have 

"failed" sober group living. 

The fundamental belief underlying Housing First and most other low demand housing strategies 

is that individuals should not be left homeless simply because they are unable or unwilling to 

maintain abstinence. Among the communities we visited, Columbus and Seattle have extensive 

harm reduction-based programs, Lamp in Los Angeles was an early Housing First and harm 

reduction developer, Philadelphia's safe havens and many of its PSH programs operate on a 

harm reduction model, as will the Housing First program it is getting ready to open, and San 

Diego has similar housing opportunities. 

Other Approaches 

In addition to harm reduction programs, we observed a number of other innovative intervention 

strategies for homeless chronic substance abusers during our site visits for this project. Two are 

expansions and enhancements of traditional detoxification programs, while a third combines 

community service and employment expectations with traditional clean and sober requirements. 

A fourth approach, San Diego's Serial Inebriate Program, has already been described in the 

Outreach section of this chapter. 

The two examples of expanding traditional detoxification programs are Maryhaven Engagement 

Center in Columbus, Ohio and the Dutch Shisler Sobering Center in Seattle. People may walk 

into these programs on their own, or be brought by outreach workers or law enforcement 

officials. Once there, they are strongly encouraged to stay and sober up and then to move on to 

longer residential treatment programs. These communities have made an effort to develop 

extended residential treatment, recognizing that without it detox is usually just a revolving door. 

Several programs for homeless chronic substance abusers in Birmingham take a very different 

tack. They require sobriety, community service, and employment, as well as attendance at 

regular meetings related to staying clean. Community service begins immediately, at a level of 

10-20 hours a week, and clearly functions as much more than a way to keep participants 

occupied. In a large focus group held in Binningham with people who had been chronically 

homeless, most said that being required to perform community service was the first time in their 

lives that anyone had treated them as if they had something to contribute, and as if they had a 

community that would care what they gave. This was the turning point and beginning of selfesteem for most people at the focus group. Community service continues even after employment 

begins, which occurs as soon as a person's sobriety indicates it is feasible. Programs have 

developed extensive networks of employers willing to hire program participants, and several 

programs said finding work for people was not a problem. Working continues the self-esteem 

boost begun by community service, and puts people on the road to self-sufficiency. Program 

graduates often help locate jobs, and some have become employers themselves, as well as 

organizers of community service opportunities. Noting that participants frequently could not 

sustain sobriety after residential treatment if they went back into the community, several 

Birmingham substance abuse programs developed transitional housing and affordable private 

housing. One has become the biggest affordable housing developer in the area, serving formerly 

28 

Chapter 3: New Strategies for Programs and Services 

homeless and never homeless low-income people alike. In Birmingham, PSH is reserved largely 

for those with serious mental illness, with or without co-occurring disorders, and people with 

AIDS. Chronic substance abusers are expected to work from very early in their recovery, to 

contribute to the cost of their program (they pay for both emergency shelter and transitional 

housing as soon as they are working), and ultimately to become self-sufficient. 

Housing Configurations and Supportive Services 

PSH housing configurations vary a great deal, which in turn affects decisions about how to offer 

supportive services and whether it is also possible to create a supportive community of tenants-. 

Completely scattered-site configurations (program participants occupy apartments wherever they 

can fmd them, usually no more than one or two in any single building) make demands on service 

delivery that are quite different from the opportunities offered by operating a dedicated building 

(one in which all tenants are part of the program). Other housing configurations include 

"clustered scattered" and mixed-use buildings. "Clustered" programs may operate a six- or eightunit building completely occupied by program participants on a block with no other such 

buildings. Mixed-use buildings are usually large (100-300 units), with 20 to 25 percent of units 

set aside for program tenants. Other tenants may be never-homeless disabled sin~les, as is the 

case at Sunshine Terrace in Columbus, a public housing authority 811 building.' Or they may be 

"regular" low-income households, as in the unit set-asides in the San Diego buildings developed 

by Centre City Redevelopment Authority. Set-aside units may be master-leased by a PSH 

program or accessed through an understanding with landlords that on average, every fourth 

vacant unit will go to a program client. Another variation on "mixed" use is a building occupied 

entirely by formerly homeless people, in which tenants may include both singles and families. 

Support services in these programs may include case management, service referrals, instruction 

in basic life skills, alcohol/drug abuse treatment, mental health treatment, health care (medical, 

dental, vision, and pharmaceutical), AIDS-related treatments, income support, education, 

employment and training assistance, communication services (telephone, voice mail, e-mail, 

Internet access), transportation, clothing, child care, and legal services. The exact mix of services 

and who provides them can vary greatly from one community to another, and even from one 

program to another in the same community. This variation is partly a result of who does what in 

different communities, and partly due to the "piece-it-together-as-best-you-can" nature of 

assembling the many types of people, agencies, and funding streams needed to create a 

successful supportive housing program. However, the variety is also partly deliberate, as 

programs and communities sort out the most effective distribution of responsibilities among 

housing developers, property managers, on-site program service staff, and services delivered on 

and off site by staff of other agencies. And it is always influenced by housing configurations. 

Issues mentioned during our site visits that affect supportive services structure include: 

16 The BUD Section 811 program provides "funding to nonprofit organizations to develop rental housing with the 

availability of supportive services for very low-income adults with disabilities, and provides rent subsidies for the 

projects to help make them affordable." (From a BUD web page program description accessed on October 26,2003 

at http://www.hud.gov/offices/hsg/mfhJprogdesc/disab811.cfm.) 

29 
Chapter 3: New Strategies for Programs and Services 

• 	 The appropriate division of labor between property management and case 

management. Most programs we visited have decided to separate these two functions, 

either by assigning them to completely different entities (such as a housing management 

company for the first and the. program for the second) or by dividing their own staff into 

distinct property management and services teams. This eliminates the conflict of interest 

that arises in handling nonpaying tenants or other. issues relating to lease conditions. 

• 	 Whether to bring services into the residential site or encourage tenants to navigate 

community service -systems. This is nota major issue in scattered-site programs, but it 

is in mixed-use and dedicated buildings. Program staff members say tenants often prefer 

that services come to them. As they use services more when the services are convenient, 

staff members have some motivation to accommodate the tenants. This is especially true 

as these are PSH programs where tenants are not expected to be working toward selfsufficiency, and the demand that they deal directly with service systems may be enough 

to prevent them from getting the services they need. 

• 	 The extension of services to tenants of mixed-use buildings who are not part of the 

program, and who were never homeless. Several communities (Columbus, at Sunshine 

Terrace; Seattle, through Plymouth Housing) have found this to be both useful and costeffective. 

• 	 How to attract tenants to services when they are free to choose to use them or not. 

Housing First and safe haven programs need to make effective offers of service, as they 

cannot require tenants to use services. Program staff in many of the communities we 

visited characterized their role as making friends, being available, making suggestions, 

checking up, hanging out, creating and then attending social events such as barbeques or 

monthly birthday parties, either not having an office or never closing the door, and other 

similar measures. Tenant word-of-mouth is the best referral; acting in ways contrary to 

tenant free choice will quickly be known and compromise one's ability to assist tenants. 

For many service professionals, this is really a whole new way of life. 

• 	 How much the on-site program staff should know about what services tenants are 

accessing. Some programs arrange for sensitive issues such as mental health and 

substance abuse to be handled by contract service providers who offer their services on 

site but independent of the program staff. Tenants make their own arrangements to see 

these service providers, and information of what they wanted and what they got is never 

conveyed to the program staff. Strict confidentiality is maintained. Other programs 

handle these issues with program staff, still maintaining strict confidentiality and 

voluntary use of services. 

• 	 How to maximize service dollars, which may also be related to facilitating tenant 

access to services. To facilitate client access, many homeless assistance programs use 

program staff, supported by grant monies, to provide health, mental health, substance 

abuse, as well as case management. Medicaid might be able to cover these services, 

freeing up grant monies, but the programs are not set up to maintain the records 

Medicaid requires, to do Medicaid billing, or to underwrite costs during what may be 

long lag times before reimbursement occurs. San Diego addresses many of these issues 

30 

Chapter 3: New Strategies for Programs and Services 

simultaneously through contracts with nonprofit and for-profit behavioral health 

companies-see Chapter 6 for a description. 

Preventing Homelessness Upon Institutional Discharge 

One of the most effective ways of ending chronic street homelessness is preventing it from 

happening in the first place. This often involves commitment of resources to assure housing and 

services, and effective discharge plalIDing from the many institutions that interface with 

chronically homeless people and those at risk of chromic homelessness: hospitals, treatment 

facilities, psychiatric-institutions, correctional facilities, and sometimes foster care. In the 

absence of effective policies and practices around discharge, many of these institutions simply 

release people into local homeless shelters. Even discharge planning without commitment of 

resources to assure stable housing, is not sufficient to prevent homelessness. Discharge plans 

adequate to prevent homelessness typically include an estimated discharge date, collecting 

medical records, and making arrangements for post-release housing, medical and mental health 

care, and other community-based services. In some states this planning is the formal 

responsibility of the agency releasing the individual back into the community, while in other 

places it is done more informally by agency staff or community-based social service providers 

(Community Shelter Board, 2002). Our study discovered many examples of important 

prevention efforts, but did not focus strongly on them because we knew that HUD has two other 

studies focused specifically on prevention. One is on discharge planning to prevent street 

homelessness among ex-offenders, and the other is a mOre general look at the workings of 

successful community programs to prevent homelessness of all types. 

Philadelphia's Housing Support Center (HSC). The HSC has a primary prevention focus for 

individuals (and families) at imminent risk of homeless ness. It began operations in winter 2003, 

and when fully operational will bring together resources from Adult Services, Department of 

Human Services (child welfare), Community Behavioral Health, the County Assistance Office 

(cash assistance), the Philadelphia Housing Authority, and other public agencies whose clients 

face challenges to housing stability. It will serve as the city's central referral point for all 

households needing help because they are facing or experiencing homelessness. Because 

Philadelphia has a homeless management information system that covers all emergency shelter 

and another that covers the street population, the city will be able to track whether people 

assisted by the HSC do indeed avoid becoming homeless. 

Psychiatric Institution Discharge Planning. A number of communities, including Boston and 

Columbus, have policies and structures in place to prevent people leaving public psychiatric 

facilities from becoming homeless. 

Correctional Institutions Discharge Planning. Boston and Los Angeles (County Sheriff's 

Department), and at least some other California cities have programs to prevent homelessness 

among mentally ill offenders leaving correctional institutions. The Los Angeles program, funded 

through California state revenues in the AB 2034 program, involves careful interagency 

coordination as part of making discharge planning work. The Program Evaluator links the client 

with an agency in the area where he wishes to reside after discharge. If no housing is available in 

the client's desired area, he is placed close by and has the option of receiving outpatient 

31 

Chapter 3: New Strategies for Programs and Services 

treatment in the program of his choice until housing becomes available. Once in the program, the 

individual may transfer between programs as the need arises. Even though the jail does not have 

a policy requiring housing upon release, the agencies participating in the AB 2034 program are 

required to locate housing and provide transportation to wherever the client will be living upon 

release. Checks ar.e in place to assure that incarcerated AB 2034 clients are not discharged to the 

streets. 

Leaving Substance Abuse Treatment. In some communities, individual agencies such as the 

Community Psychiatric Clinic in Seattle and Aletheia House in Binningham have created a 

continuum of housing options, starting with residential treatment and including transitional, 

permanent supportive, and affordable independent housing, because they perceived that many 

such clients became homeless without these options. Both programs serve people who have 

never been homeless as well as those who have. They offer primary prevention to the former, 

and secondary prevention to the latter. 

Client-Level Coordination Mechanisms 

In addition to strategies involving new types of programs and new treatment philosophies, we 

encountered quite a number of mechanisms for assuring that individual clients get the services 

they need. These client-level service coordination mechanisms are the grease that makes the 

wheels go round for the new strategies and philosophies. Without them, clients would not have 

the same chance of getting the services they need, especially when they have many and complex 

needs that require assistance from many types of agencies. These client-level coordinating 

mechanisms include databases, various multi-agency team and co-location mechanisms. 

Databases 

One way that community agencies can promote appropriate service delivery to individual clients 

is to share information about the services that each provides. A number of communities use 

database technology to do just that. Some communities have created databases specifically for 

the homeless popUlation and services while others use existing databases to track their clients' 

use of mainstream services or systems. Using databases allows staff members of one agency to 

know what services someone might be receiving from others, and plan their own service delivery 

accordingly. Shared databases also help agencies avoid unnecessary service duplication. 

Databases are useful at each level of community interaction and can be forms of communication, 

coordination, or collaboration, depending on how agencies related to each other overall. 

King County's Mental Health Information System is a database used for both communication 

and coordination purposes. King County's Mental Health System has a Mental Health 

Information System logging any person's use of county mental health services. This database has 

become a source of useful information for Seattle's homeless service providers that are also 

certified mental health providers such as the Downtown Emergency Service Center. Individuals 

who have used system services have a record in the shared database and get a rating, or tier, for 

their service needs. To enroll a new client, he or she must first be on or eligible for Medicaid. 

Then the agency serving the client will apply for a tier based on medical necessity and treatment 

32 

Chapter 3: New Strategies for Programs and Services 

intensity. The county will review the tier request and grant or deny the tier. Once tiered, the 

person can begin to receive ongoing publicly funded treatment. 

The Mental Health Information System serves a communication function related to service 

duplication. The database logs the person's tier and the agency that provides care within the 

mental health system; two agencies cannot serve the same individual and both receive 

reimbursement for the care. The database thus prevents mental health service duplication and 

encourages some interaction among agencies to provide. the most appropriate services. For 

example, if an outreach worker begins to provide outreach and engagement services to a street 

homeless individual who already gets services from another agency, the worker will reconnect 

the person to the original 'agency to continue services. Or if the person seems to need the specific 

services of the agency doing outreach, the staff will contact the other agency and ask them to 

stop providing services to the individual so they can begin to. 

The Mental Health Information System also serves a coordinating function in Seattle between 

mental health service providers and local hospitals and jails. Once a person is logged in the 

database, a countywide agreement assures that local jails and hospitals notify the mental health 

provider if its client becomes incarcerated or is admitted for services. Then the mental health 

provider is encouraged to contact the client to re-establish or refme service linkages. 

Other communities use database technology as part of their collaborative work. The San Diego 

REACH Project (Reaching Out and Engaging to Achieve Consumer Health) makes use of an 

existing database to assist its clients. This program, operating under the aegis of the San Diego 

County Mental Health Services Department, contracts with the San Diego County Probation 

Department to have a probation officer assigned to work directly with the REACH team. The 

officer is able to access the Department of Corrections database and helps many REACH clients 

clear up outstanding legal issues (e.g., warrants, criminal background checks) in her role as 

liaison between clients and the courts. 

The Greater Los Angeles Department of Veteran Affairs (VAGLAHS) created a database to 

assist with its work with agencies in its collaborative network. Staff members developed a 

discharge/service history database that provides the ability to track the service-use patterns of 

individual veterans. The discharge/service history database logs individuals' use of services 

throughout the whole homeless services network. V AGLAHS program and partner agency staff 

members contact the V AGLAHS database coordinator to provide client data and the database 

coordinator also periodically contacts partner agencies to ensure that all data have been 

submitted. Partner agencies also contact the database coordinator to learn about a new enrollee's 

history of service receipt and use the information to develop an appropriate service approach. 

V AGLAHS staff liaisons to partner agencies also use this database to review veteran status and 

to ensure appropriate referral and service plans. 

Philadelphia's OCC, which was discussed above in this chapter's section on outreach, is a 

particularly strong example of a collaborative service network using an integrated database. The 

agencies collaborate to integrate outreach efforts so that different teams cover different areas of 

the city and/or different issues of immediate concern. The collaborative has created a database to 

log the outreach and case management contacts. Outreach workers can also access shelter and 

33 

Chapter 3: New Strategies for Programs and Services 

transitional housing infonnation by li.nkjng into the database maintained by the city that tracks 

this infonnation. 

Multi-Agency Special Case Teams 

In addition to the multi-agency teams that collaborate on a day-to-day basis, such as those 

discussed in this chapter's outreach section, there are teams that collaborate on a case-by-case 

basis or for a particular subset of the client population. Multi-agency special case teams may 

work for agencies that recognize the utility of combining approaches and integrating services, 

but may not have the resources to address the needs of all clients so they focus on cases meeting 

particular criteria. 

An example ofa multi-agency special case team is Seattle's High Users of Crisis Public Services 

team. Every two weeks staff members from the Crisis Triage Unit in the Harborview Medical 

Center Emergency Room, the REACH project (an outreach and case management project for 

chronic public inebriates), the emergency room, the Sobering Center, the detoxification center, 

the Emergency Service Patrol (a transport system for chronic public inebriates) and other 

relevant service providers meet to discuss high service users. These are people who have used 

the Crisis Triage Unit four times in three months, of which 52 percent are homeless. Together the 

agencies create integrated service plans for clients that each provider commits to following. This 

system allows service providers to think together creatively about client needs and the types of 

services that would be helpful to particular individuals, focusing especially on services designed 

to reduce their reliance on expensive public services. Clients sign infonnation releases so 

agencies can coordinate in this way. At times the Triage Unit may also involve the client, family, 

friends, or police representatives. 

In Los Angeles, the V AGLAHS collaborative network is another example of a multi-agency 

special case team. The VA has an administrative requirement that a homeless veteran is only 

eligible for three complete treatment episodes in residential programs. If a person requires more 

than three episodes in housing, then the VA is required to seek a waiver for the person. The 

network uses the discharge/service history database just described to see whether a person has 

reached his service limit. When that happens, staff members from the V AGLAHS and relevant 

collaborating programs, as well as the veteran, come together in a clinical case conference to 

develop an approach to care to meet the person's needs at that point. The group develops a 

service plan and integrated service approach that the participating agencies commit to following. 

If necessary, the V AGLAHS staff will apply for a waiver for a client. 

Multi-Purpose Service Centers 

Another way that agencies collaborate around services for chronically homeless people is to 

develop mUlti-purpose service centers where clients can receive more than one type of service 

within the same building. The goal of such "one stop shopping" arrangements is to increase a 

homeless person's access to services. Homeless individuals may need, but not seek, more than 

one service, or be willing to go to more than one location. By offering multiple services at one 

site, agencies are better able to comprehensively meet the needs of clients. 

34 
Chapter 3: New Strategies for Programs and Services 

VAGLAHS's Comprehensive Homeless Access Center. The VAGLAHS operates the 

Comprehensive Homeless Access Center for homeles-s- veterans. VA GLAHS staffrealized that 

homeless veterans had multiple needs and designed the Access Center to co-locate primary 

medical care, mental health, and homeless services. The structure of the access center 

dramatically changed "business as usual" for VA medical services. Now, a nurse conducts a 

complete bio-psycho-social assessment on clients including medical, treatment, and housing 

needs. The nurse will also review the person's history of using VA medical and homeless 

services within. the LA system and the larger V A network. The veteran receives a comprehensive 

treatment plan addressing all bio-psycho-social issues including referrals to appropriate services. 

Referrals to services are then prioritized according to need. 

Access Center clients receive same day appointments and immediate medications, which is very 

important to homeless individuals who may have difficulty keeping appointments. Homeless 

veterans can receive emergent, urgent, or routine medial care (such as physicals) the same day 

they access the center. Those needing emergent or urgent care are transferred to the V AGLAHS 

hospital on campus and those needing routine care are sent to the second floor of the building 

where the primary care facilities are based. The veterans shower and receive clean clothes before 

receiving medical care. Homeless veterans now have physicals the same day they come into the 

center as opposed to waiting six to eight weeks for a physical as they did before the center 

opened. 

V AGLAHS staff members realize housing increases stability and stability increases the 

likelihood that veterans will follow up with additional medical services and appointments. 

Therefore, in addition to immediate medical care, homeless veterans accessing the center 4re 

directly linked to housing. Staff members fmd homeless veterans temporary housing in 

transitional programs that have openings in their collaborative network and are appropriate to the 

needs of the particular veteran. 

Veterans experiencing severe psychiatric problems such as delusions or suicidal ideations are 

sent to the psychiatric emergency room. Otherwise, psychiatrists conduct same day assessments 

for those experiencing less emergent psychiatric problems. The clients are then referred to the 

mental health clinic's orientation program given provided weekly. 

After the triage process described above, about 80 percent of the clients are referred to a social 

worker for more detailed assessments of complex issues. Together the veteran and social worker 

develop referral plans to address other needs, such as substance abuse treatment and social 

service needs. The social worker continues to provide case management and follow-up services 

with the Access Center clients as long as necessary. The Access Center also provides the fust 

time user with a hot lunch from the campus cafeteria. There are plans to begin providing dental 

care to homeless veterans in summer 2003 . 

• 	 Seattle's Dutch Shisler Sobering Support Center. The Sobering Support Center was 

built and is owned by Community Psychiatric Clinic and co-locates three connected 

programs collaborating to provide services for chronic public inebriates: the Sobering 

Support Center itself; the Emergency Service Patrol; and the REACH Project. The 

Sobering Support Center, funded by King County, cares for people as they sober up. 

Another county program, The Emergency Service Patrol, operates a van that picks up 

35 
Chapter 3: New Strategies for Programs and Services 

vulnerable homeless people from the streets and brings them into services. Sobering 

Support Center staff members refer clients to REACH, which provides case management 

services. REACH staff members target the most vulnerable and difficult to serve, who are 

likely to make heavy use of the Sobering Center. REACH workers assist clients to apply 

through the Department of Social and Health Services for state Alcohol Drug Abuse 

Treatment and Support Act funds, eligibility for which opens the door to all chemical 

dependency services in Seattle. This fund provides cash assistance to people who are 

disabled due to addiction as long as they are in treatment and have a payee. REACH also 

provides its clients direct links to housing, a good part of which grew out of CPC 

advocacy. A number of Seattle housing providers are more willing to take REACH 

clients because the project is well respected. 

• 	 For a person in King County to receive public mental health services, he or she must flrst 

be entered into the county's mental health database. The database, an outgrowth of 

ACCESS, tracks every client's mental health service use and also logs the agencies that 

provided the care. Several agencies dealing directly with street homeless people are part 

of this system. Because two agencies serving the same client cannot both receive 

reimbursement, the database is also used to prevent service duplication and encourages 

some service coordination. Any agency interviewing a prospective new client will check 

with the database to see if the person is already in the system. If yes, staff will reconnect 

the person to the original agency or, if the person seems to prefer the new agency steps 

are taken to reassign the service responsibility. The database also provides opportunity 

for coordinating mental health services with local hospitals and jails, as these latter 

institutions can check the database and, if there is a provider of record, connect a person 

to that provider. 

Processes to Alter Access to Mainstream Settings 

Homeless individuals require many services and supports beyond what homeless service 

providers offer (Burt et aI., 2002). Many of the services and supports are provided through 

mainstream agencies that do not speciflcally have a focus on homelessness, including mental 

health, substance abuse treatment, and social service agencies. HUD encourages communities to 

use mainstream agencies when serving homeless people. Mainstream agencies have increased 

involvement in serving the chronically street homeless population through new roles in old 

agencies and co-location of services. 

Co-location ofService Providers in Mainstream Agencies 

One way that mainstream agencies have increased access to their own services and supports or 

access to other agencies' services for their own clientele is through co-location. Co-location is 

when staff members from one agency are located within the building of another agency to reduce 

barriers to services. For example, Seattle's Downtown Emergency Service Center has outreach 

staff located at the Department of Health and Social Services one day a week so eligibility 

workers can refer clients directly to the person for services if necessary. The Los Angeles County 

Sheriffs Department has created the Community Transitions Unit to empower jail inmates to be 

36 

Chapter 3: New Strategies for Programs and Services 

successful once they leave custody. Homeless veterans are one of the unit's target populations. 

The unit staff members. contact VAGLAHS to verify veteran status of inmates prior to placement 

in the veteran portion of the facility. (Offenders can be in the veteran portion of the facility as 

long as they are not mentally ill or are not charged with murder or sex offenses. Mentally ill 

inmates are housed in a different portion of the facility). The VAGLAHS, US Vets, and the 

Salvation Army each have staff located in the facility to provide services and classes to veterans. 

Services include assessments for treatment, drug and rehabilitation classes, parenting classes, 

personal relationship classes, computer training, job skills, and resume building. 

New Roles in Old Agencies 

Some mainstream agencies in the communities we visited have altered their philosophy by 

accepting greater responsibility for serving chronic street homeless people. These agencies have 

reduced barriers and increased access to their services. 

Philadelphia. The city Office of Emergency Shelter and Services (OESS) maintains two central 

intake systems, one for single men and one for women with or without accompanying children. 

Emergency shelter occupancy went from about 80 percent to 97 percent once the central intake 

system was fully operational. While it does not run any shelters or transitional programs itself, 

the city pays for shelter for all people that OESS places into emergency or transitional programs. 

The intake databases link to a management information system that can provide an unduplicated 

count and other information about people served, going back to 1989. 

The Housing Support Center is a new program just getting under way within the city Office of 

Adult Services (AS). When fully operational, it will bring together resources from AS, 

Department of Human Services, Community Behavioral Health (CBH), the County Assistance 

Office (cash assistance), the Philadelphia Housing Authority (PHA), and other publjc agencies 

whose clients face challenges to housing stability. It will serve as the city's central referral point 

for all households needing help because they are experiencing homelessness or facing 

homelessness, including families whose involvement with child welfare arises chiefly from their 

lack of housing. 

Agencies under Philadelphia's Behavioral Health System offer prevention, outreach, substance 

abuse, and mental health services through their own staff and by contracting with nonprofit 

homeless assistance programs. The Coordinating Office of Drug and Alcohol Abuse Programs 

and the Office of Mental Health are city offices whose staff provides care directly and who also 

pay for services and shelterlhousing through contracts for people meeting their eligibility criteria. 

Both work closely with the outreach teams under the Outreach Coordination Center run by 

Project H.O.M.E., as well as supporting outreach teams of their own. Direct mental health and 

substance abuse treatment is also supplied through CBH, the city's nonprofit managed 

behavioral health care entity covering poor people with behavioral health disorders, whether 

Medicaid beneficiaries or not. All are components of Philadelphia' s Behavioral Health System 

(BHS). 

Los Angeles. The Department of Mental Health (DMH) Adult Systems of Care admjnisters the 

AB 2034 program in Los Angeles County. AB 2034 is a state-funded program to address the 

37 

Chapter 3: New Strategies for Programs and Services 

mental health needs of persons whose illnesses have led them to homelessness and incarceration. 

In Los Angeles, these funds focus on _providing appropriate supports to incarcerated people with 

serious mental illness, to prevent (return to) homeless ness upon release. They thus link DMH and 

the County Sheriff-s Department in a new and important partnership. 

Several mainstream agencies cooperate in providing outreach for the program. Most AB 2034 

clients enter the program from jail. When jail staff members identify a prospective AB 2034 

client, they contact the Program Evaluator who begins the intake process into the AB 2034 

program to determine program eligibility. At this point, the agency initiates the engagement 

process and remains connected with the client during incarceration. While in jail, the inmate is 

followed by one of two AB 2034 case managers who advocate for the client and work with the 

sheriffs department to produce an effective discharge plan. Referrals can also come from the 

courts, prosecutors, parole officers, county mental health programs, self-referrals and referrals 

from family members. The AB 2034 Program Evaluator works with police departments, 

prosecutors, and parole officers to negotiate alternative sentencing programs for inmates who 

qualify for the AB 2034 program. 

The Adult Systems of Care's Housing Coordinator provides technical assistance to the agencies 

in leasing and purchasing housing and in completing applications for Section 8 housing 

vouchers. The Housing Coordinator also works with the Los Angeles City Housing Authority on 

a case-by-case basis to apply for exemptions for clients with criminal histories. 

AB 2034 funds give Housing Specialists the flexibility to overcome property owner resistance by 

employing such innovative strategies as paying the rent until the client receives hislher housing 

voucher and placing an early deposit on a housing unit so the property owner will have funds 

available to make necessary repairs to bring the building up to Section 8 standards. The Housing 

Specialists can also intervene if an eviction is imminent or use AB 2034 funds to repair any 

damage done by the client. To recruit more landlords willing to rent to AB 2034 clients, the 

Department of Mental Health hosted a landowner/property owner breakfast for which they 

brought in speakers to speak on such topics as how to become Section 8 landlords and how to 

obtain low interest loans. 

The Housing Specialists have made such an impact that some landlords have taken their names 

off the BUD Section 8 list and only rent to AB 2034 clients. Not only do the housing specialists 

provide technical assistance and temporary fmancial relief for Section 8 landlords serving their 

clients, but the AB 2034 clients come with case managers who resolve problems between tenants 

and landlords. 

Conclusions 

Housing First, safe haven, low demand, and harm reduction approaches, which usually occur in 

combination, appear to be very successful at attracting chronically street homeless people. Focus 

groups of street homeless people and outreach workers interviewed during site visits attest to 

their attractiveness, as do these communities' evidence of successful recruitment into permanent 

supportive housing and publicly available reports (Anderson et aI., 2000; Rosenbeck et aI., n.d.; 

Shern et aI., 1997; Tsemberis and Eisenberg, 2000). Chronically homeless disabled people will 

38 

Chapter 3: New Strategies for Programs and Services 

come in, they do use services even though not required to, they do reduce their substance use, 

and mostly they do not retum to the streets. 

In addition to the new approaches, making a commitment to ending chronic homelessness often 

means increasing the availability of existing programs and services that help people to leave 

homelessness. These might include increasing access to case managers, reducing case manager 

caseloads, expanding short- and medium-term addiction recovery programs (for those who will 

accept them) that fill gaps so people are not left without a program when they are not yet secure 

in their recovery, increasing availability of housing subsidies, and so on. It takes many 

components to create a successful system. Some will be new, others old. Birmingham, for 

instance, has some successful programs based entirely on sobriety and transitional rather than 

permanent supportive housing. But serious commitment to ending chronic street homelessness 

necessitates a paradigm shift, part of which involves the willingness of a community and its 

homeless assistance providers to consider approaches that have been proven to work even though 

they may, at least initially, represent a significant departure from traditional programs. 

A number of agencies in the communities we visited have found innovative ways to address 

client needs. Some agencies do this within their own structure, such as through mini-continuums. 

Other agencies have accessed resources through other organizations in the community and 

developed structures where they interact to provide services to chronically street homeless 

clients. Many of the communities have collaborative relationships between agencies to serve this 

population such as those working in multi-agency teams, multi-agency special case teams, and 

multi-purpose service centers. Others have at least developed communication and coordination 

mechanisms to try to improve services for the chronically street homeless population. Many 

communities have also taken advantage of database technology to increase their interactions and 

knowledge flow perhaps thereby improving services for clients. 

39 

Chapter 3: New Strategies for Programs and Services 

40 

CHAPTER 4: ASSEMBLING RESOURCES AND SUPPORTS 

Once communities· recognized that existing programs and services were not reducing or ending 

chronic homelessness, committed themselves to that goal, and identified potentially successful 

strategies, they still faced the task of assembling the resources and supports needed to implement 

their plan. In Chapter 2 we identified the sources of those supports--commitment and investment 

from mainstream agencies, the business community, local elected officials, and the general 

public. Each source may contribute interest, leadership; funding, staff, collaboration, and 

willingness to change. 

Previous chapters have been organized by topic, illustrated by examples from several 

communities. In contrast, this chapter is organized by community to show how each community 

drew together the elements necessary to succeed. We first describe developments in two 

communities with long histories of cooperative investment in homeless programs and servicesPhiladelphia and Columbus. As will be seen, even these communities still had to make their case 

for new strategies and gather resources and supports. We then present two examples of 

developing new goals and strategies in the absence of any previous structure or commitmentSan Diego and the Veterans Affairs Greater Los Angeles Healthcare System. Finally, we give an 

example of what has been accomplished in Seattle to assist chronically homeless people with 

mental illness and substance abuse problems, even without a change in the larger community 

toward a commitment to end chronic street homelessness. 

Assembling Resources in Communities with Long Histories of Support 

Philadelphia and Columbus are two communities with a very long track record of organized 

commitments to homeless assistance programs and services. Each already had an effective 

organizational structure, the commitments of local elected officials, extensive mainstream public 

agency involvement and investment, and general public support. Yet each still had to mobilize 

resources once it defined a new direction. 

Philadelphia 

Trigger Event. In 1998 a City Council member introduced a bill to criminalize many of the 

behaviors and actions of homeless street people. The proposed legislation galvanized the 

homeless advocacy community and brought a great deal of pressure to bear on the Council. The 

city ordinance eventually passed, but not before it had been changed in major ways and carried 

with it significant new funding to provide alternatives to street homelessness. 

The response to the sidewalk behavior legislation was a remarkable example of what 

Philadelphia respondents mean when they say there is no progress without tension, "as long as 

we all still talk with each other." Downtown businesses wanted to do something to decrease the 

odds that people coming downtown to shop, do business, attend conventions, or visit tourist 

attractions would encounter panhandlers or people living on the streets. Advocates countered 

wi th two tacks-1) arresting people would just add a criminal record to their other difficulties in 

leaving homelessness, and 2) if you want to get people off the streets, you have to offer some 

41 
Chapter 4: Assembling Resources and Supports 

alternatives that they are willing to take. The Open Door Coalition, a group formed in 1997 to 

develop viable plans for permanent long-tenn supportive housing for homeless individuals, 

solicited support from the media and community residents to protest the Sidewalk Behavior 

Ordinance in its original form. After a good deal of controversy, and conversation, the results 

were: 

• 	 An ordinance passed, and is still city law. 

• 	 Proscribed sidewalk behavior is not criminalized, however. Instead, police may issue a 

ticket similar to a parking ticket, and then only after making several attempts to offer 

shelter or other assistance themselves, calling an outreach worker, and having the 

individual refuse any type of assistance from the outreach worker. 

• 	 New services were authorized to provide alternatives to living on the street, and about $5 

million annually in new money was authorized to pay for them. The services include: 

~ The Outreach Coordinating Center (OCC), its management and oversight 

activities, and its outreach teams (see Chapter 3); 

~ Four new safe haven residences, comprising 85 new low demand beds for 

substance abusers, mentally ill individuals, and those with co-occurring disorders; 

~ New commitments to PSH. 

• 	 The police department established a special Homeless Outreach Team to work with OCC 

outreach and respond to street emergencies. 

Mainstream Agency Involvement. As a conscious part of Philadelphia's approach to ending 

chronic street homelessness, many city agencies serve this popUlation. Most use their resources 

to fund homeless assistance programs or supportive services and case management; many also 

offer some programs and services with their own staff. All participate in weekJy and monthly 

meetings of city agency heads, and in one or more of Philadelphia's three citywide coordination 

mechanisms-the annual Strategic Planning Conunittee, the Blueprint to End Homelessness, and 

the Mayor's Task Force on Homelessness. Philadelphia's history in the homeless arena attests to 

its willingness and ability to entertain new ways of doing things when the situation warrants. The 

city began developing PSH in the early 1980s, long before McKinney funds became available for 

this purpose. In the early 1990s it served as a model and one of the sites for the Program on 

Chronic Mental Illness, a national demonstration of supported housing funded by mID and the 

Robert Wood Johnson Foundation. Over the years the city has thoroughly changed its approach 

to outreach (from night to day, and much-increased coordination), and developed targeted 

responses to street homelessness in its no/low demand programs. 

Private Sector Involvement. The Center City District, Philadelphia's downtown Business 

Improvement District, has been active since at least 1991 in addressing street homelessness, 

including providing jobs for homeless and fonnerly homeless people. Earmarking funding in 

response to the Sidewalk Behavior Ordinance to expand street outreach was in part a response to 

concerns of the business community. Street outreach has been crucial in helping homeless 

individuals move off the street; which met a business community objective to improve 

dovmtown visiting attractions. The Center City District's concern for street homelessness 

translated directly into funding and running an outreach team; its daytime outreach approach 

proved so useful that it became the model that Philadelphia outreach efforts now follow. 

42 

Chapter 4: Assembling Resoillces and Supports 

Committment from Local Elected Officials. The City Council supported and passed the 

revised Sidewalk Behavior Ordinance and approved additional funding for all of its provisions. 

The current mayor established the Mayor's Task Force on Homelessness even before he took 

office as another response to street homelessness. With almost 70 members representing every 

possible interested party, the Task Force addresses issues related to street homelessness, 

especially in the center city area. These issues include outreach, access to shelter reSOillces, 

police/community/ homeless person relations, differentiating between panhandling and 

homelessness, running public education campaigns, services delivered "on the street," and 

similar issues. Members include representatives from the city council, businesses, faith 

communities, neighborhood and civic associations, homeless services providers, relevant 

government agencies, the Chamber of Commerce, legal and housing advocates, universities, the 

Convention Center and Visitors Billeau, the Center City District, and private foundations. 

Role of Consumers in Advocacy and Shaping Policy. Homeless people themselves have been 

involved from the beginning in advocacy and actions to bring attention to the needs of people 

without shelter for the night. Homeless advocates have been very successful in rallying 

community support on the issues of homelessness in the political arena. For example, during the 

1999 election of Philadelphia's mayor, homeless advocates formed a nonpartisan coalition called 

"Election '99: Leadership to End Homelessness," which educated the community through 

forums and workshops on the issues of homelessness, publishing and distributing more than 

10,000 copies of the Voters' Guide on Homelessness and Housing, and registering over 2,000 

homeless and low-income individuals to vote. Members of the coalition also organized a forum 

with the mayoral candidates, attended by more than 800 people, to examine the candidates' 

strategies for creating additional affordable housing units as well as obtaining their commitment 

to find solutions to end homelessness. The coalition has also been active in statewide senatorial 

and gubernatorial elections. 

Columbus 

Trigger Event. The Rebuilding Lives initiative grew out of a request by the City of Columbus in 

August 1997 for a plan to address the needs of people experiencing housing crises who were 

being affected by the development of the Scioto Peninsula, a riverfront corridor in downtown 

Columbus where many street homeless people congregated. In response to that request, the 

Community Shelter Board, with the support of the Franklin County Board of Commissioners, the 

City of Columbus, and United Way of Central Ohio, established the Scioto Peninsula Relocation 

Task Force, which issued the Rebuilding Lives plan in October 1998. The letter introducing the 

Task Force's report is addressed "To the Franklin County Community." Columbus views ending 

homelessness the responsibility of the entire community, not some smaller group such as the 

Community Shelter Board, homeless service providers, or elected officials. Launched in July 

1999, the Rebuilding Lives initiative focuses on ending homelessness and'rebuilding lives' by 

meeting the short-term needs of homeless individuals through an improved safety net of 

emergency shelters and by establishing 800 units of stable supportive housing programs for 

homeless individuals with long-term needs. 

Mainstream Agency Involvement. A major focus of the original Rebuilding Lives plan was 

identifying and securing the reSOillces needed for implementation. The plan outlines several 

options for new fmancial reSOillces: establishing dedicated local revenue SOillces for broad-based 

43 

Chapter 4: Assembling Resources and Supports 

affordable housing activities; encouraging innovative, entrepreneurial businesses tied to 

programs serving homeless individuals; and generating private, state and Federal funding for 

specific projects. Resources for Rebuilding Lives are managed through a specially created 

"Funder Collaborative" that allows individual funding agencies to pool their resources to achieve 

mutually agreed-upon goals, establish common expectations about what outcomes are to be 

achieved, and specify what reporting requirements are needed to document progress towards 

those goals. Funder Collaborative members include elected representatives of city and county 

government, all of the major public agencies, private agencies such as the Corporation for 

Supportive Housing, and philanthropic organizations such as the United Way and various local 

corporate donors. Key members are the Alcohol, Drug and Mental Health Board of Franklin 

County (ADAMH), which coordinates all community-based alcohol, drug .addiction, and mental 

health services in Columbus; the Columbus Metropolitan Housing Authority; and the 

Departments of Job & Family Services and Health. 

Mainstream agency commitment to the larger goals of Rebuilding Lives is clear from many 

actions, of which we describe only one here. Recognizing a gap in services for people with 

addictions who were not also mentally ill, the Maryhaven Engagement Center was designed and 

developed to improve on existing detoxification facilities and offer a more inviting entree to 

services for male and female public inebriates. This is a population whose treatment is vital to 

the success of Rebuilding Lives. Funded by the Community Shelter Board, the ADAMH Board, 

and HOD support for safe havens, the Center has an overall capacity of 54 beds and provides 

overnight accommodations and services. Clients may remain in the Engagement Center for three 

days without receiving substance abuse treatment, or ten days if they participate in Maryhaven's 

outpatient detoxification program, which is right next door. Individual inebriates, however, can 

be admitted to the engagement center as often as needed. The usual stay is for one night. Once 

someone enters the Engagement Center, attempts are made to engage him or her in substance 

abuse treatment and other services working towards the goal of permanent housing. 

Private Sector Involvement and Local Elected Officials Commitment. Rebuilding Lives has 

a great deal of community support and political backing, building upon the same elements in 

Columbus' long-standing commitment to addressing the issues of homeless ness in a unified way 

through the Community Shelter Board. The executive director of the Community Shelter Board 

explained that both Columbus and Franklin County have high quality elected officials and the 

community has a long-standing tradition of caring about people, not just homeless people. The 

message is "bipartisan and very moderate- you don't have to support us because you like 

homeless people, you can just not like homeless people on the street in front of your business." 

Also, the business and political leadership mentors itself and ensures that this tradition of caring 

for and helping others continues over time. 

Mobilizing Resources "From Scratch" 

Two of the communities we visited provide examples of how resources and supports were 

mobilized when no prior structure of commitments or relationships existed that had a primary 

focus on homelessness. San Diego mobilized business community, mainstream agency, and 

ultimately political support for a commitment to end street homelessness in the downtown area, 

overcoming a long history of government disinterest and lack of cooperation between city and 

county government agencies and elected bodies. In Los Angeles, the history of the current 

44 

Chapter 4: Assembling Resources and Supports 

collaborative network of public and private agencies serving homeless veterans reveals the roles 

of advocacy and political commitment in demanding a new goal and stimulating a public agency 

to devote the resources needed to reach it. 

San Diego 

The Role of Trigger Events. As downtown San Diego revitalized during the 1990s, the issue of 

street homelessness and what to do about it became a focus of discussion. In 1998, a camp-out 

by homeless advocates in front of the municipal building grew over the course of a few months 

from a few people to more than 300. Initially -sent to remove the campers, the police department 

drew upon its problem-solving, community-oriented approach and sought a positive resolution. 

After interviewing campers, officers realized that the issues raised required responses beyond 

anything the police could muster, and began a process that ultimately produced San Diego's 

Homeless Outreach Team (see Chapter 3 and Appendix G). 

Also in 1998, the-decision was taken to build a new major league ballpark downtown, in an area 

that had become the most recent center of street homelessness. Anticipating displacement, 

residents in nearby areas began raising concerns about where homeless people would move next, 

while downtown businesses expressed concerns about "doing something serious" to reduce street 

homelessness. The impending ballpark development galvanized San Diego businesses and 

government agencies to get serious about reducing street homelessness in a responsible way. 

Mainstream Agency Involvement. Interested parties from public agencies and the business 

community began meeting and soon constituted themselves the Ad Hoc Committee on 

Downtown Homelessness. The Committee serves as the major coordination mechanism for 

planning, assembling resources, and developing programs related to ending street homelessness. 

From the beginning of this response, the downtown redevelopment agency (Centre City 

Development Corporation-----CCDC), businesses (the Downtown San Diego Partnership), the San 

Diego Police Department, and the courts were extensively involved, as were the city's housing 

authority (San Diego Housing Commission) and its Department ofCommunity and Economic 

DevelopmentiDivision of Homeless Services. 

The Committee has no formal existence, which members say is its strength. Members described 

their initial process as "our approach was to sit around the table and ask ourselves what should 

our approach be." Committee members think their success is due to the many conversations they 

had, and their commitment to seeking information until they felt they knew what they wanted to 

do and something about how they wanted to do it. New agencies and stakeholders were invited 

to participate as it became clear to the fIrst organizers that their roles were vital to success. The 

Committee's unbureaucratic and unofficial nature allows each participating agency and 

organization to be frank about its issues and tensions, as well as about its resources and abilities. 

Attendance by agency heads means that the power is present to make decisions, commit agency 

resources, and see that plans are carried to completion. Peer-to-peer accountability once 

commitments have been made keeps things moving forward, and peers can help troubleshoot 

bottlenecks and barriers and offer their own resources to help regain momentum if things do not 

work as expected. 

45 
Chapter 4: Assembling Resources and Supports 

A very significant addition to the San Diego effort was the opening of a regional office of the 

Corporation for Supportive Housing (CSH). It provides a team member that has full time staff 

focused on the issue of supportive housing. Courting the CSH-to open an office in San Diego 

was an important achievement of the Ad Hoc Committee, and in turn the CSH presence adds 

strength and stability to the Committee's work. 

Private Sector Involvement. CCDC works closely with the business community. The portfolio 

of one staffer includes responsibilities to "solve problems" in the downtown area, so 

homelessness fell into her bailiwick. In addition, the chair of the CCDC Board of Directors 

became very interested in the issue and provided essential leadership. The President of the 

Downtown San Diego Partnership, who was also an advocate for mentally ill homeless people 

and a political activist, played a key role in educating the business community and bringing it to 

the table. Guest speakers educated both Partnership and Ad Hoc Committee members about 

homelessness, the relation of mental illness and co-occurring disorders to homelessness, and best 

practices elsewhere in the state and country to address the needs of chronically homeless people. 

Two people more than any others spearheaded San Diego City's activity on the Committee---4.me 

was a planner from the City Manager's office, and one was a private developer who was in 

charge of the ballpark development. The former, who estimates she spent about half her time for 

a year on the effort, is described as "the glue that kept it all together." They attribute their 

success in their roles to their neutrality-they started the process knowing nothing about 

homelessness or homeless programs, but being willing to learn and having no preconceived 

ideas. They went everywhere, asked endless questions, brought fresh perspectives to existing 

programs, and thought about "why couldn't we do X?" rather than "we've never done it that 

way." The combination of their politics also helped-----one was a liberal public servant, the other a 

conservative businessman. When both of them agreed on a course of action, they tended to carry 

the day with audiences across the political spectrum. By December 1999, the Committee's fivepart program to assist the special needs homeless popUlation had been presented to and approved 

by the San Diego City Council. Its parts included: 

• 	 Creating a centralized intake and referral system and locating a facility; 

• 	 Building transitional housing beds for special needs homeless people; 

• 	 Building permanent supportive housing units for special needs homeless people; 

• 	 Expanding residential alcohol and drug treatment programs for substance dependent and 

dually diagnosed homeless people; and 

• 	 Evaluating and expanding the Police Department's Serial Inebriate Program. 

Commitment from Local Elected Officials. Part of the Ad Hoc Committee's success lies in 

drawing in players from both the city and county, in a spirit of cooperation that was 

unprecedented in San Diego up to that point. When the Committee was ready it asked for, and 

got, an historic, first-time joint meeting of the City Council and County Board of Supervisors. 

These two bodies committed themselves to the plans offered by the Committee and to working 

together to make them happen. This public commitment was an important policy progress. The 

City Council and Board of Supervisors created a Joint City-County Homeless Program 

46 
Chapter 4: Assembling Resources and Supports 

Committee and appointed two members from each body to serve on it. These members in tum 

assigned staffers to work on the committee, which held regular meetings at which staff of city 

and county agencies reported progress toward various goals and discussed ways to reduce any 

barriers that arose. This Joint Committee became an important avenue through which city and 

county agencies could talk to each other and develop collaborative plans. 

Los Angeles Veterans Affairs 

The history of how the Veterans Affairs Greater Los Angeles Healthcare System (V AGLAHS) 

developed its current system is a dynamic example of how advocacy stimulated political 

commitment, which in tum changed public agency leadership and resource commitments. The 

result is a greatly changed and expanded system addressing the needs of many chronically 

homeless veterans who were not being served before. Developments began with increased 

communication-initially adversarial but changing to information gathering and open dialogue. 

The fmal system is fully collaborative, with each partner working together in newly developed 

ways to achieve the goal of ending homelessness for many disabled veterans. 

Role of Advocacy in Developing Political Commitment. During the late 1980s and early 

1990s, even the health services available to homeless veterans through V AGLAHS were limited, 

and only about six transitional housing beds were available. Homeless service providers and 

advocates appealed to the V AGLAHS administration and demonstrated on V AGLAHS' Los 

Angeles campus to obtain more services for homeless veterans. The group met resistance locally, 

which inspired them to go to Washington, DC to inform congressional leaders about the lack of 

services for homeless veterans. This movement resulted in a congressional hearing on the Los 

Angeles campus grounds, with representatives ofVAGLAHS and community agencies giving 

testimony. 

During the same time frame, staff from a community based organization, New Directions, 

wanted to begin providing services to veterans in one of the many empty buildings on the LA 

campus, but met great resistance to this idea. The organization worked to get an act of Congress 

to acquire a building on the campus, which occurred in 1989/ 1990.17 The building is now the site 

of the New Directions South program. 

Mainstream Agency Involvement. After the congressional hearing, V AGLAHS began to 

respond. The VA established a new administration at V AGLAHS in the early 1990s, and created 

a department focused on homeless services (McGuire, et aI., 2001). VAGLAHS leadership began 

to communicate with agencies about what veterans needed and how to develop a collaborative to 

address those needs. To further complicate the VAGLAHS situation, the West LA Health Care 

Center was downsizing its inpatient health care services because of lowered resources at the 

same time that the V AGLAHS was trying to expand its homeless service approach. 

Recruiting Partners. V AGLAHS leadership recognized that it needed community organizations 

to adequately serve chronically homeless veterans, who face many barriers to service. The V A 

17 The lease was eventually signed in 1995, until then the program provided services to veterans living in housing in 

the community. 

47 
Chapter 4: Assembling Resources and Supports 

proceeded to develop partnerships with community agencies from 1992 through 2000, creating a 

network that now includes 11 private and 7 public agencies in Los Angeles city and county. The 

network's goal ino assist veterans to leave the streets and lead productive lives by addressing 

four needs: (1) access to health care and treatment; (2) income from benefits and/or employment; 

(3) stable housing; and (4) support networks. The collaborative network approach is based on the 

premise that no single agency can provide comprehensive services to meet these four needs. The 

network includes programs that range from unstructured drop-in centers to treatment facilities. 

Private agencies have developed a total of930 new transitional housing beds for veterans- up 

from the 6 beds that were available in 1992 and the largest number in the country connected to a 

VA facility. 

Progress Without Community-Level Commitment to Ending Chronic Homelessness 

We encountered some examples of important developments for the street homeless population 

even in communities without a central guiding vision at the community level of ending street 

homelessness. Some of these examples used Federal funding opportunities to promote significant 

service development and interagency cooperation. We give one example-Seattle's service 

structures that capitalized on participation in the Center for Mental Health Services' Access to 

Community Care and Effective Services and Support (ACCESS) demonstration program that 

began in 1993. 

Seattle Program Structure Growing Out ofACCESS 

A Federal funding opportunity had an important impact on Seattle's programs for the chronically 

street homeless population. Federal guidelines for the five-year ACCESS project, in which 

Seattle's Community Psychiatric Clinic and Downtown Emergency Services Center (DESC) 

participated, emphasized cross-agency systems and services integration. This gave strong 

impetus to Seattle providers and government agencies to develop outreach and engagement 

services for chronic street homeless individuals. Through its assertive outreach, ACCESS found 

new pockets of homelessness and helped chronic street homeless persons through the eligibility 

process for health and human services. It helped spark system innovations in Seattle and King 

County services, such as the merger of the mental health and chemical dependency divisions of 

county government and adding a housing specialist to this staff (now called the Mental Health, 

Chemical Abuse, and Dependency Services Division, King County Department of Community 

and Human Services). The demonstration [mdings persuaded county government that it should 

continue to fund programs such as those operated through ACCESS, which would avert public 

outlays for back-end services such as jail and hospital costs. 

Service Development and Mainstream Agency Linkages. The Systems Design Workgroup 

formed within ACCESS to examine and recommend changes in system functions related to 

homeless mentally ill people. A Chronic Public Inebriates workgroup formed at the same time in 

response to a county executive request, and developed an action plan to create appropriate 

services and housing. When the mental health and chemical dependency divisions of county 

government merged in 1998, the two groups also merged, renaming the new entity the Chronic 

Populations Action Council (CP AC) in 2002. These groups pushed with ultimate success to 

develop a number of specialized services for the chronically street homeless population. These 

48 

Chapter 4: Assembling Resources and Supports 

include the Harborview Medical Center Behavioral Health Crisis Triage Unit, the Mental Health 

Court, the Dutch Shisler Sobering Support Center, the REACH Project, the mental health 

detoxification enhancement project, the Emergency Service Patrol, and pre-recovery and 

recovery-oriented housing projects such as the Archdiocesan Housing Authority's Wintonia 

project and a new DESC housing project. 

The Dutch Shisler Sobering Support Center operations and the mental health database, already 

described in Chapter 3, illustrate the complex inter-agency relationships that had to be developed 

to make these programs work, and that still continue to serve chronically homeless people today. 

Private Sector Involvement. The Downtown Seattle Association, a local business association 

focused on downtown business community concerns including social service policy, provides 

leadership in the area of chronic street homelessness. This group helps gamer support from 

neighbors and improve community relations for projects serving this population. Specifically, it 

supports DESC's work and has been instrumental in the development of the new pre-recovery 

housing project being designed by DESC. 

Conclusions 

The examples described in this chapter show how a central guiding commitment has helped the 

communities that have one to mobilize the resources and supports needed to fulfill their goal of 

ending street homelessness. They also show that mobilization is necessary whether or not a 

community habitually invests generously in homeless assistance programs and services. 

Changing one's paradigm means changing one's goals and adopting new strategies to achieve 

them. Either communities must fmd new resources to develop these new strategies, or they must 

redirect old resources. As no one likes to take money away from functioning programs, the price 

of political support from existing programs almost always means fmding new resources. 

Communities with a history of strong support for homeless assistance may have a somewhat 

easier time convincing potential funders that the new direction is the right one, because their 

track record of responsible system management makes them a credible source of new 

information. But they still have to make the case, just as did people in San Diego and the Los 

Angeles V A once they had convinced themselves of the direction they wanted to follow. It is 

certainly possible to develop good programs, and even good cross-agency cooperation, without a 

central guiding vision, as some of the Seattle programs demonstrate. But it is not as easy, and the 

pieces may have a harder time retaining their "systenmess" when the pressures that brought them 

together disappear. 

49 

Chapter 4: Assembling Resources and Supports 

50 

Chapter 5: Documenting Progress 

CHAPTER 5: DOCUMENTING PROGRESS 

We sought out programs and communities that could document that their approaches were 

achieving progress in reducing chronic street homelessness. Tbis evidence took several forms: 

• 	 Changes in the number of people found on the street from year to year; 

• 	 Increases in the number of chronically street homeless people who have moved into 

permanent housing; 

• 	 Reductions in costs of providing emergency health, mental health, and shelter services; 

and 

• 	 Reductions in days homeless, hospitalized, or incarcerated. 

In presenting the evidence we gathered from the study, we do not want to create the impression 

that success was under community control if it only tried hard enough. Many factors may 

influence the level of homeless ness in a community, no matter how organized or complete the 

efforts to end it. Interviewees in the communities we visited noted that factors tending to increase 

chronic homelessness included a poor economy and resulting unemployment, shutting down one 

or more large SRO hotels where poor single people had lived, closure of state mental hospitals, 

and persistently bigh housing costs. Furthermore, the study communities' were generally more 

successful than most at tapping into Federal and, to a lesser extent, state programs reducing 

chronic street homelessness. Non-local resources have played a significant role in supporting 

integrated, community-wide approaches involving mainstream agencies and permanent 

supportive housing. Spreading such approaches nationwide will entail Federal and state 

commitments. 

Changes in the Number of People Found on the Street from Year to Year 

Counts of street homeless persons are a basic method of determining changes in the number of 

people found on the street from year to year. A difficulty in such counts is ensuring that the 

numbers do not change because of variations in definitions and completeness of coverage. Street 

counts are much more valuable if they are done regularly using the same methods. If the territory 

covered changes from year to year, it is also most useful if analysts report a time series of data 

for the same area. For example, Seattle has extended the geograpbic coverage of its annual street 

count, but also reports changes over time within a fixed core area. Street counts are also more 

valuable to a community when they gather data that will help with service planning, such as 

individuals' characteristics and needs, and cover homeless individuals residing in shelters or 

other program housing. 

Despite the difficulties in maintaining consistency of coverage, street counts are the most direct 

measure of reductions in chronic street homelessness. Philadelpbia, Birmingham, Seattle, and 

Boston have all conducted a series of street counts that we judged to have sufficient coverage 

and consistency to allow comparisons over time. One of our standards was that persons in 

emergency shelters should be counted as homeless, but not persons in permanent supportive 

housing. These four communities collected and presented their data in a manner that met this 

51 

Chapter 5: Documenting Progress 

standard, or from which equivalent statistics could be calculated. We also checked to see that 

there were consistent guidelines in place for dealing with situations such as people sleeping in 

cars and abandoned warehouses. Finally we were concerned that attention was paid to the issue 

of whether there were changes in the geographic area of coverage. While recognizing that these 

communities do not have perfect coverage or consistency in their street counts, we think they are 

useable, direct measures of street homelessness. 

Philadelphia Counts ofStreet Homeless Persons 

Street counts conducted by Philadelphia's Outreach Coordination Center between 1998 and 2003 

indicate positive outcomes from developing alternatives to living on the streets, including safe 

havens and permanent supportive housing (see Chart 5.1). Since 1998, outreach workers 

coordinated through the OCC have conducted quarterly street counts over an area that includes 

all of downtown and west and southwest Phiradelphia. Summer counts declined from 395 in 

1998 to 228 in 2000. Since 2000 the count has increased, reaching 370 in 2003 . Interviewees at 

the site attributed the increased street homelessness to a downturn in the city's economy. Also 

since 1998, h{)wever, over 300 PSH beds have been created which presumably kept the street 

count from going even higher as the economy worsened. 

Chart 5.1 


Counts of Street Homeless Individuals in Philadelphia, 1998-2003 


450 

395 

400 

350 

300 

250 

200 

150 

100 

50 

0 

1998 1999 2000 2001 2002 2003 

52 

Chapter 5: Documenting Progress 

Birmingham Street Counts 

Binningham has done periodic counts of homeless persons complemented-by a sample survey of 

the people counted. To provide a complete profile of the chronic homeless individuals in a 

COffil-nUnity, a "street count" needs to go beyond the people on the street and include homeless 

individuals housed in emergency, transitional, treatment. Birmingham's counts provide a good 

example of the scope necessary. The number of homeless living on the street declined by onethird from 330 in 1995 to 220 in 2003, with most of the decline occurring between 1995 and 

2001 (see Chart 5.2). This decline was achieved by "sheltering" and "housing" more people, 

because the sum of street homeless persons and homeless persons in programs providing shelter 

or housing increased from 1,404 in 1995 to 1,667 in 200 I. By 2003 the sum of street homeless 

and persons in programs had declined slightly to 1,616. 

Chart 5.2 


Counts of Street Homeless Individuals, Birmingham 1995-2003 . 


400 

350 330 

300 

244 

250 220 

200 

150 

100 

50 

0 


1995 2001 2003 


Street counts are a valuable tool for examining whether the total CoC system is succeeding in 

lowering homelessness, however, unless background history is collected one cannot determine 

what is behind the trends. A rising street count could be from many causes such as fewer 

individuals moving into housing, increasing migration of homeless individuals to the 

community, reduced state mental hospital beds forcing people with severe mental illness onto the 

streets, a new epidemic of substance abuse, declining housing for very low income individuals, 

increased job layoffs, or some combination of these and other factors. Birmingham's 2003 

Homeless Survey included questions to shed light on the causes of homelessness. The survey 

also gathered information on age, sex, race, ethnicity, family status, education, income, veterans 

53 

Chapter 5: Documenting Progress 

status, disabilities, health care, and homeless services being received. However, complete data on 

these other items are not yet available. 

Seattle Street Counts 

The SeattlelKing County Coalition for the Homeless oversees an annual one night street count 

and sw-vey of homeless shelters and transitional programs that have been conducted for 24 years 

(Seattle/King County Coalition for the Homeless, 2003). The sw-vey of shelters and transitional 

programs is conducted the same night as the street count and produces unduplicated numbers of 

people using homeless services at the time of the count. The coalition returns annually to the 

same areas of the city and county to count street homeless individuals and also adds new 

neighborhoods to the count periodically. When comparing numbers of street homeless year -after 

year, however, the coalition does some analyses that use a constant geographic area to avoid 

increases in numbers being attributable to the increase in area. From 1999 to 2002 the One Night 

Count of street homeless individuals went up 81 percent in "traditional count areas" from 983 to 

1,779. From 2001 to 2002 the total count of street homeless individuals went up 40 percent from 

1,454 to 2,040, but a substantial portion of that was from adding three new areas to the count. 

From 2001 to 2002, restricting the analysis to the 2001 geographic area, the number of street 

homeless individuals increased 23 percent in one year. From 1998 to 1999, during better 

economic times, a same geographic area count of street homeless individuals still went up 16 

percent in one year. 

During the 1999 to 2002 period, these increases in street homelessness occurred despite a 21 

percent increase (from 4,917 to 5,940) in the sw-vey count of the number of homeless individuals 

in shelter or transitional shelters. The community is losing ground while making improvements 

in resources for homeless individuals. One explanation is that homeless individuals are drawn to 

or sent to Seattle from surrounding communities. Our focus group of homeless individuals 

indicated that Seattle was known to be a relatively "good" place to be homeless. In the October 

2002 One Night Count sw-vey of shelters and transitional housing, 46 percent of the respondents 

indicated that their last permanent address was outside the City of Seattle. In the late 1990s there 

were skyrocketing housing prices in Seattle and some tearing down of single room occupancy 

buildings, and these economic pressures probably pushed more people on to the streets because 

they could not afford the available housing. More recently the job market has soured, and our 

interviewees reported that rising unemployment is also creating economic factors that result in 

more people being on the street. Even if people laid off do not become homeless, some may 

move to low rent quarters, making the affordable housing market tighter. 

Of those using services in Seattle in 2002, 60 percent were single adults in shelter or transitional 

housing. Less than 1 percent used a safe haven. Forty-one percent of the homeless people using 

services were female and 38 percent were white (compared to 80 percent of the general 

population), 37 percent were African American (compared to 5 percent of the general 

population), 10 percent were Hispanic (compared to 3 percent of the general population), 5 

percent were Native American (compared to 1 percent of the general population), and 4 percent 

were AsianlPacific Islander (compared to lO percent of the general population). The most 

frequently cited disabilities among homeless people using services were mental illness and 

chemical dependency. 

54 
Chapter 5: Documenting Progress 

The increase in Seattle's homeless population can be attributed to many challenges that 

overwhelmed the efforts of programs to tackle the issue of chronic street homelessness. Seattle 

has seen an economic downturn at the same time affordable housing has decreased. Indeed, 

individual program data from DESC, CPC, and AHA indicate these programs are successful in 

assisting chronically street homeless individuals into permanent supportive housing. 

Boston Street Counts 

Beginning in 1986 the ESC has conducted annual street counts in Boston with the assistance of 

over 250 volunteers who cover designated geographical areas in the city to enumerate homeless 

individuals sleeping on the streets and in the city's shelters and other homeless facilities. 

According to the December 2002 annual street count, the total number of homeless individuals 

residing on the streets of Boston and in adult emergency shelters has increased over the last 

decade: 

The number of Boston's homeless increased by 41 % in the past decade. There were 6,210 

homeless people in the City of Boston in 2002 compared to 4,411 in 1992. There were 1,367 

homeless children in Boston in 2002 compared to 800 in 1992, an increase of 71 %. There 

were 1,572 homeless women in 2002 compared to 989 in 1992, an increase of 59%. There 

were 3,271 homeless men in 2002 compared to 2,622 in 1992, an increase of25%. Although 

the number of homeless men rose at a slower rate than that of women and children, they 

remained the largest percentage of the population, 53%. The majority of these men have 

chronic disabilities such as mental illness and/or substance addiction (Menino, 2002, p.2). 

The increase in the number of homeless individuals can be traced directly to a number of 

conditions, including but not limited to: 

• 	 The dramatic rise in housing costs; 

• 	 The decrease of affordable housing for low-income persons; 

• 	 A reduction of substance abuse treatment beds; and 

• 	 A lack of commitment to aftercare planning and next step resources for individuals 

being released from jails and prisons, acute mental health facilities, hospitals, and social 

servIces. 

In an effort to track the demographic information on homeless individuals, the city of Boston has 

contracted with the Center for Social Policy at the McCormack Institute, University of 

Massachusetts to implement Connection, Service and Partnership through Technology, which 

maintains the HMIS data system. Formerly known as the ANCHOR project, the HMIS data 

system is used by over 40 providers and enables Boston to collect and track unduplicated 

information on over 4,750 homeless individuals and 350 homeless families in Boston in order to 

provide unduplicated services and other resources needed to assist homeless individuals move 

towards self-sufficiency and permanent housing. 

Last year, provider data revealed that at least 1,500 homeless people obtained permanent housing 

throughout the city of Boston, including 550 chronically homeless individuals. The Pine Street 

55 

Chapter 5: Documenting Progress 

Inn NBOR Project, which serves chronically street homeless people, reports that of 356 clients 

who exited the program in the past two years, 38 percent (134) obtained permanent housing and 

another 22 percent (77) were referred into a~rransitional housing program. The majority of clients 

in 2001-2002 were successfully placed into housing and more than 60 percent of them (103 of 

171) entered housing after more than four years ofhomelessness (another 19 percent had been 

homeless between one and four years). The program achieved similar results more recently in 

2002-03: 58 percent (108 of 185) of those housed had been homeless from 4-6 years, and 26 

percent (48 of 185) had been homeless for 1-4 years. Most of the individuals successfully placed 

are repeat users of health care, mental health care, substance abuse, and shelter services and the 

locus of care and services simply shifted from the streets to fixed-site programs that served as a 

staging area for their successful placement into transitional and permanent housing. 

Chronically Homeless Individuals Moved to Permanent Housing 

Philadelphia Movement ofChronically Homeless Individuals into Permanent Housing 

Permanent supportive housing is one avenue that may help chronically homeless people with 

disabilities move off the streets and into stable housing. We asked the major PSH providers if 

they had data that could document whether residents of their PSH units had been chronically 

homeless and whether they had achieved housing stability in PSH programs. Two providers, 

Project H.O.M.E. and Resources for Human Development (RHD), were able to provide relevant 

data. 

Project H.O.M.E. provided data about residents in the four safe haven programs (with 80 beds) 

that are coordinated through OCC, and about residents in its five PSH projects (with 121 units) 

for single adults. Since inception, the safe havens have served 539 clients. All safe haven 

residents are either mentally ill, substance abusers, or both, as well as being likely to have other 

problems. Data on length of homelessness before entering a safe haven are available for 160 

people, of whom 47 percent had been homeless for longer than 1 year, with 32 percent being 

homeless for 2 years or more. Among the 399 people for whom previous living situation is 

known, 30 percent came from the streets and other non-housing locations, 17 percent came 

directly from mental health or substance abuse treatment facilities, and 36 percent came from 

emergency shelters or a different safe haven. Among the 537 people whose length of stay at a 

safe haven is known, 52 percent stayed for 6 months or less, and 30 percent stayed for more than 

1 year, with an average length of stay of 1.3 years. Information about current living situation is 

available for 516 people, of whom 23 percent still live at the safe haven, 36 percent moved to 

better housing situations (such as PSH, own housing, with family), 2.5 percent died; 22 percent 

left for situations that were similar or less desirable, and current whereabouts could not be 

ascertained for 18 percent. 

Project H.O.M.E.'s PSH programs have served 187 people since July 1, 1999. Among the 122 

people for whom length of previous homelessness is known, 67 percent had been homeless for 

one year or more, with 44 percent of these experiencing homeless spells of at least 2 years. 

Length of stay in PSH is available for all 187, among whom: 

• 136 (73 percent) stayed for at least 2 years; 

56 
Chapter 5: Documenting Progress 

• 93 (50 percent) stayed for at least 1 year: 

• 51 (27 percent) stayed less than 1 year; and 

• The average length of stay was 3.2 years. 

Of the 90 people who left Project H.O.M.E.'s PSH, current whereabouts are known for 86 

percent. Of these, only 13 percent are living in situations that would be considered homeless, 

including on the streets, in emergency shelters, safe havens, or transitional housing programs. 

The rest are in a variety of stable housing situations. 

RHD has served 121 consumers since 1995 in its Supported Adult Living Team (SALT) program 

and another 25 (since 1989) in its Boulevard Apartments. RHD provides supportive services to 

people with serious mental illness living in scattered-site residential units (SALT) or multi-unit 

building rent-subsidized apartments. Ofthese 146 consumers, 45 came directly from 

homelessness. Most of the remainder, all in the SALT program, had significant periods of 

homelessness although their immediately prior residence was various transitional housing 

situations. Of these 146 individuals, 72 percent stayed for one year or more, including 

• 61 (42 percent) who stayed for at least 2 years; 

• 23 (16 percent) who stayed for at least 18 months but less than 2 years; and 

• 21 (14 percent) who stayed for at least 12 but less than 18 months. 

San Diego Movement ofChronically Homeless Individuals into Housing 

San Diego's AB 2034 program for chronically homeless individuals with mental illness enrolled 

404 persons between November 1, 1999 and January 31, 2003 in permanent supportive housing. 

It offered people immediate housing in a variety of settings, using hotels in the early period 

before safe haven and PSH slots became available. At the end of this period, 253 were still 

enrolled and 154 had been disenrolled for various reasons (59 percent of the 154 "disenrollees" 

dropped out of the program and another 17 percent moved out of the REACH program area). 

Presumably most clients should be staying in permanent housing for a long period. If too large a 

percentage disenrolls, the program is having problems. Agencies can use simple length of stay in 

permanent housing to make some assessment of how a system is working. If the typical length of 

stay is six to eight months in a program designed to provide years of residence, the support 

services may be insufficient or the program may be taking in clients who do not need that high a 

level of care and are moving on to independent living. However, this does not appear to be a 

problem for the PSH programs we visited. Far more often providers noted that turnover among 

clients was much lower than expected, even after years of residence. Some communities are now 

beginning to think about lower-intensity options for tenants who have been stabilized for several 

years. 

57 

Chapter 5: Documenting Progress 

Birmingham Movement ofChronically Homeless Individuals into Permanent Housing 

The Cooperative Downtown Ministries (CDM) has placed 189 persons into its transitional 

housing program since 2000. When placed about 80 percent were chronic street homeless 

individuals, 85 percent were substance abusers, 33 percent had a serious mental illness, and 

about 23 percent were dual diagnoses. The transitional housing program's capacity was 30 

individuals, but has recently been expanded to 87. Of the 189 persons who have been in the 

program, 17 percent are still there, 49 percent left for permanent housing, 19 percent have 

unknown whereabouts (most are thought to be in housing with family or friends), 10 percent 

went to another program or jail and 5 percent left the program for other reasons. 

The CDM opened its own PSH program only a few months ago; but has· been placing people 

from its transitional housing program into other PSH programs. Many others have been 

connected directly to other permanent housing programs by CDM shelter's case manager without 

going through CDM's transitional housing program. Of the 75 who went from its transitional 

housing program to a permanent supportive housing program, 47 percent have remained at least 

24 months, 21 percent at least 18 months, 13 percent at least 12 months and 19 percent less than 

12 months. 

Reductions in Costs of Providing Emergency Health, Mental Health, and Shelter Services 

In Columbus existing shelter data indicate a 7 percent decrease in the total number of clients 

sheltered in 2001 as compared to 1998 (note these are all homeless clients, not just those who are 

chronically homeless). Of the 2,959 clients sheltered in 2001,298 had successful outcomes, 

meaning they exited the shelter system to either permanent or transitional housing. The average 

length of stay during this period of time remained relatively stable for men, while it increased by 

over 20 percent for women, increasing from 37 days in 1998 to 47 days in 2001. During tills 

period of time the recidivism rate increased by 14 percentage points for men and 3 percentage 

points for women. 

Despite the limitations of the HMIS, the Community Shelter Board has been collecting extensive 

data on its homeless service system for many years, data that have guided both program and 

policy development in Columbus. These data have been used to evaluate the costs of rwming 

various Rebuilding Lives programs The two-pronged strategy at the heart of the plan (emergency 

housing for those in crisis and supportive housing for those with long-term needs) was largely a 

response to the fact that chronically homeless people (a group that accounts for only 15 percent 

of all those in need of homeless assistance) were absorbing the bulk ofthe community's 

homeless assistance resources. The Task Force recognized that the needs of this high-cost group 

could be met much more effectively, and at a lower cost, by providing them with permanent 

housing with supportive services. Table 5.1 is drawn from the Task Force's initial report: 

58 

Chapter 5: Documenting Progress 

Table 5.1 


Per-Bed Costs for Operations and Services of Franklin County Service Systems 


Used by Homeless Men with Long-Term Needs 


Annual Cost Daily Cost 

Service System per Bed per Bed 

Service-Enriched Housing $13,000-14,000 $36-38 

Minimum Security Misdemeanor Jail $ 21,188 $58 

Sub-acute Medical Detox $ 69,800 $191 

State Psychiatric Hospital $172,900 $482 

Hospital Inpatient $396,025 $1,085 

Source: "Report of the SCIoto PeDlnsula RelocatIOn Task Force," FlDal Report October 1998, drawIng on data from tbe Ohio 

Department of Rehabilitation and Correctons; Columbus Health Department; Ohio Department of Mental Health; Maryhaven; and the 

Community Shelter Board. 

With these figures in mind, the Community Shelter Board, service providers and funders, 

launched the initiative in July 1999. 

In Philadelphia as elsewhere, 10 to15 percent of shelter users are absorbing half or more of 

shelter resources, at significant public expense. The idea that these people could be moved to 

housing and helped to maintain it through supportive services is appealing, in that it would help 

people leave the streets and save emergency shelter resources for true emergencies. In 

Philadelphia at present the city pays for about 2,100 shelter beds a night, comprising about 80 

percent of the city's emergency shelter capacity. This number is down about 10 percent from 

2001, reflecting the deliberate effort to switch occupancy from emergency to permanent 

supportive housing for chronic shelter users. Philadelphia is just starting its first program based 

on a pure "Housing First" approach, bypassing even the safe haven stage of moving from street 

to housing. Research evidence on housing first models has convinced officials that this is an 

important model to try. 

In San Diego the Serial Inebriate Program (SIP) did a cost analysis showing the very high levels 

of public resources being absorbed by serial inebriates, compared to the costs of treatment. They 

calculated a cost of $977 for maintaining one serial inebriate in housing plus outpatient substance 

abuse treatment for one month, compared to $1,470 for the cost of one police contact with an 

ambulance visit to the emergency room followed by a day in jail. The SIP participants were all 

people with very long histories of addiction and street homelessness, and all were treatment 

resisters. Nevertheless, over 3 years the program has an average annual completion rate of over 

40 percent compared to average completion rates for voluntary substance abuse treatment 

programs for homeless people of between 20 and 33 percent, with most falling at the lower end 

(Orwin et al., 1994). 

Also in San Diego the Homeless Outreach Team (HOT) Program asked the UCSD Medical 

Center to track care received by 15 mentally ill chronically homeless individuals well-known to 

the HOT workers at Scripps Mercy Hospital, UCSD Medical Center, and the San Diego 

59 

Chapter 5: Documenting Progress 

emergency medical services system during an 18 month period from July I, 1997 through 

December 31, 1998. The 18-month cost just for these 15 individuals was just under $1.5 million, 

which did not include physician fees or care that might have been incurred at other regional 

hospitals. UCSD physician charges totaled $87,017 for both in- and outpatient care for these 

same individuals during the study time period. HOT's expenditures of $69,820 a person a year to 

get chronic street homeless people with multiple disabilities into stable housing situations are 

close to the medical expenditures noted above, which would be $67,000 a person a year. If the 

costs of other public services such as law enforcement were added to the equation, HOT 

expenditures might be substantially offset by savings to other agencies, at least for the HOT 

participants who were high consumers of these services. 

Among the communities we visited for this study, few had conducted cost avoidance studies of 

any complexity. Those we just documented form San Diego are fairly simple, yet have been 

effective in raising public consciousness that "doing nothing" is not free and that there may be 

better ways to invest public money, with more humane consequences as well as more livable 

downtowns. In recent years, several studies examining public crisis costs avoided as a result of 

offering permanent supportive housing or other service alternatives have been published and 

have excited national attention. The most prominent of these, by Culhane, Metraux, and Hadley 

(2002), was a key stimulant to development of national policy urging an end to chronic 

homelessness. Other similar analyses have been conducted for PSH programs in Connecticut 

(Anderson et aI., 2000) and San Francisco (Martinez and Burt, 2003; Proscio, 2000). The most 

recent entry in the field is a three-year follow-up study of homeless veterans in a joint program 

of HUD and the VA that randomized assignment to housing plus case management versus just 

case management versus "usual services" (Rosenbeck et aI., 2003). The results of most of these 

studies show that a considerable proportion of the costs of PSH and supportive. services may be 

compensated for by savings stern.millg from reduced use of public crisis services such as 

emergency rooms and public hospitals. 

Reductions in Days Homeless, Hospitalized, or Incarcerated 

In San Diego among the 253 formerly homeless clients currently enrolled, REACH had the 

following impacts, annualized to represent the 12 months before compared to the 12 months after 

enrollment, current enrollees have: 

• 	 73 percent fewer homeless days; 

• 	 55 percent decrease in incarceration days, and 71 percent decrease in incarceration 

episodes; 

• 	 35 percent decrease in hospital days, and 62 percent decrease in hospitalization episodes; 

and 

• 	 506 days of enrollment, on average, or about 1.4 years, in a program that in January 2003 

had only been at full enrollment for about 2 years; 55 percent had been enrolled at least 

one year. 

The Los Angeles AB 2034 program can show statistics with similar impacts, as can the program 

statewide. In Fiscal Year 2002-2003 the state expenditures for the program were $55 million, but 

the state estimates that at least $27 million was saved by the reductions in utilization of other 

60 

Chapter 5: Documenting Progress 

services (Davis, Johnson and Mayberg, 2003). Programs providing these statistics are one of the 

reasons the program has been funded for the current fiscal year at the same level, despite the 

extreme state budgetary pressures (Davis, Johnson and Mayberg, 2003). 

In the Veterans Affairs Greater Los Angeles Health System (VAGLAHS), increasing housing 

options for homeless veterans, along with other changes in the system, helped to reduce the 

length of stay in medical, surgical, and psychiatric beds between 1994 and 1998 (McGuire, et ai., 

2001). The length of stay was reduced in medical beds by 28 percent, in surgery beds by 7 

percent, and in psychiatric beds by 35 percent. Not only are programs assisting the VAGLAHS 

in decreasing the length of stay in their treatment and medical facilities, but the programs have 

also assisted the facility so they are not discharging patients to the streets, from which they will 

quickly cycle back. Both community program and V AGLAHS representatives report that the 

collaborative allows them to serve veterans better, and in a more cost-effective manner. 

Conclusions 

The primary ways that our study communities documented the progress of their approaches were 

through counts that showed reductions in the number of street homeless individuals, increases in 

the numbers of chronic homeless individuals being moved into permanent supportive housing, 

reductions in the costs of providing emergency services to homeless individuals, and decreases in 

the number of days that clients spent homeless, hospitalized or incarcerated. However, 

documenting progress is not an easy or straightforward process. None of the data described 

above is readily available in most communities. Furthermore, a community may have programs 

that are functioning well, but still have outcome measures, such as street counts, that are showing 

undesirable trends because of increases in the homeless population being driven by external 

events like slumps in the economy and/or reduction in state facilities for the mentally ill. 

61 

Chapter 5: Documenting Progress 

62 

CHAPTER 6: HOW COMMUNITIES PAY FOR THEIR NEW APPROACHES 


Introduction 

Funding is, of course, the fuel that propels programs and services for ending chronic street 

homelessness. Housing is the single resource that does the most to end homelessness for 

chronically homeless and other homeless. people alike. Housing is generally expensive to create 

and, because rent subsidies are likely to be a long-term need, expensive to help people occupy. 

Add to the costs of the housing itself the costs of the supportive services that help chronically 

disabled people maintain housing, and it is evident that most commonly used 'approaches to 

ending chronic street homelessness require a good bit of funding. The cost of permanent 

supportive housing has prompted researchers and advocates to show that leaving chronically 

disabled people homeless is far from free, by identifying the costs of public crisis services used 

by chronically homeless people who do not have permanent supportive housing (Andersen et aI., 

2000; Culhane, Metraux, and Hadley, 2002; Martinez and Burt, 2003). As these costs have 

proven to be virtually as high as the costs of the programs themselves for severely disabled 

former street people, more communities are recognizing the value to public health and wellbeing of reducing street homelessness through providing housing and supportive services. 

This chapter describes funding streams that communities use to support services and housing to 

end chronic street homelessness. The communities we visited have different resources available 

and therefore take different approaches to funding for this popUlation. Some communities such 

as Philadelphia, San Diego, and Boston have access to a great deal of local and state funding, 

compared to what is typically found nationwide, which makes a difference in how they can 

tackle street homelessness. Communities such as Birmingham, however, have to be more 

creative in fmding resources because they have far fewer state or local supports. 

We fIrst explore local, state, and Federal sources of funding that at least some of our seven 

communities have called into use to serve the chronically street homeless population. 

Additionally, we describe the ways in which communities use and blend resources to help both 

providers and clients. Provider overload is eased by "funnel agencies" that assemble monies 

from various sources and allow providers to write one application to access different funding 

streams. Client access to services is enhanced by providers with multiple funding sources that 

allow them to serve clients regardless of insurance status, and bill the care to the appropriate 

payors. 

Local Funding 

The communities in this study used local funding such as general revenue, special taxing 

mechanisms and private sector resources to help fmance the cost of programs to reduce chronic 

homelessness. 

63 

Chapter 6: How Communities Pay for Their New Approaches 

General Revenue Resources 

All the communities we visited invest some local general revenues in=homeless assistance. Most 

target some of these resources specifically to efforts directed at reducing chronic homelessness. 

J,Ve highlight two communities here-Boston and San Diego. 

Boston has substantial local public resources committed to serving the homeless population. It 

focuses on solving its affordable housing crisis and expanding affordable housing for lowincome and homeless individuals and families. The mayor and the Strategic Homeless Planning 

Group (SHPG) have developed a three-year strategic plan, Leading the Way, to build 7,500 new 

affordable housing units (3,200 of these will be in new affordable developments or in reclaimed 

public housing now vacant) and to preserve 10,000 units of existing affordable housing. The city 

is contributing over $30 million plus city-owned land to achieve the plan's goals. To date, 34 

percent of the city's affordable housing units are targeted to low-income households (those 

earning less than 50 percent of Area Median Income ). While this income level is far higher than 

formerly street homeless individuals are likely to attain, easing the affordable housing crunch on 

all low-income households reduces the odds that these households will ultimately contribute to 

the homeless population through housing crises. 

The City of San Diego funds outreach services-the Homeless Outreach Team (HOT) and the 

Serial Inebriate Program (SIP)--through its police department, as described in Chapter 3. These 

programs have a high success rate and recover their costs by reducing expenditures on arrests, 

transportation, bookings, detox, and emergency services. 

City, county, and state money support San Diego's REACH program, which we describe in 

Chapter 3. The San Diego Housing Commission helps fund most of the housing portion of the 

program while the state-funded AB 2034 program supports mental health and other services 

through a flexible funding pool that will cover "whatever it takes." The county and city contract 

with non-governmental agencies to provide case management and supportive services. 

Special Taxing Mechanisms 

Several of our communities had the advantage of funding for housing development and 

operations through special taxing mechanisms created by state or local law. In addition to 

housing trust funds that are becoming more common throughout the country, we found some 

interesting mechanisms whose proceeds were being used to create permanent affordable housing 

for formerly street homeless people-tax increment fmancing in San Diego, a housing tax levy 

in Seattle, redevelopment bonds in Philadelphia, and general revenue bonds for mental health 

and substance abuse services in Columbus. 

Tax increment financing. San Diego's downtown redevelopment agency, Centre City 

Development Corporation (CCDC), helps to create new developments and economic activity, 

generating new tax revenues for the jurisdiction. California law stipulates that the redevelopment 

authority receive back a share of these additional taxes (called tax increments), and says that the 

authorities must invest at least 20 percent of the money they get back to increase affordable 

housing (tax increment fmancing, or TIF). CCDC invests these funds in affordable housing 

64 

Chapter 6: How Communities Pay for Their New Approaches 

proj ects, and has chosen to require some of them to set aside about one-fourth of their units for 

permanent supportive housing for the special needs street homeless population. 

Property tax levies. Two of our communities, Seattle and Columbus, make significant use of 

voter-approved property tax levies to support housing and services, some of which benefit people 

who are or have been chronically homeless. 

Seattle has a long history of voter-approved tax measures to fmance low-income housing and 

housing for homeless people. Voters approved housing levies in 1981, 1986, 1995, and 2002. 

The 2002 housing levy totals $86 million over seven years with the cost to the average 

homeowner of$49 per year. I

8 The program includes five major initiatives plus administrative 

costs: rental preservation and production (provides housing to people with disabilities, elderly, 

homeless, and working families and resources for rehabilitation, new construction, or 

redevelopment of units); home ownership for low-income working families; neighborhood 

housing opportunity program with a mixed income, mixed use emphasis; rental assistance to 

prevent homelessness; and operating and maintenance (for rental units for extremely low-income 

individuals and people with disabilities). 

In Columbus, the Alcohol, Drug and Mental Health Board of Franklin County (ADAMH) 

coordinates all community-based alcohol, drug addiction, and mental health services for the city 

and county, including those addressing the needs of street homeless people and formerly 

homeless people now in permanent supportive housing. Almost half of the ADAMH system's 

resources are drawn from a single property tax levy (approved by voters); the remainder comes 

from state, Federal, and private sources. ADAMH does not provide any direct services, but 

contracts with a network of 45 public and private health care agencies to treat people in need. 

Redevelopment bonds. Philadelphia's Redevelopment Authority recently obtained City Council 

approval for about $300 million in redevelopment bonds. Proceeds are being used to fund 

property acquisition and demolition as part of the mayor's Neighborhood Transformation 

Initiative. Some part of the housing being developed will be used for permanent supportive 

housing for formerly homeless disabled people. A much larger proportion will be used to 

preserve existing affordable housing and create more. 

Use ofPrivate Sector Resources 

Given the paucity of public funding for homeless programs and services in Birmingham, 

providers have developed a number of approaches that build on the resources and interests of the 

private sector. Two nonprofit agencies that develop transitional and permanent housing (with and 

without supports) have had success approaching owners of dilapidated and wholly or partially 

vacant properties to see if they will donate the property. If they will, the agencies use capital 

financing from the Federal Home Loan Bank and private lenders, plus Low Income Housing Tax 

Credits, HOME funds, and donations from religious congregations and private individuals to 

renovate and make repairs. Property owners get tax write-offs on properties that were losing 

money and causing problems, the agencies get free buildings they fix up and use, neighborhoods 

18 Seattle Office of Housing website - www.cityofseattle.netfhousing 

65 
Chapter 6: How Communities Pay for Their New Approaches 

get renovated and supervised buildings in place of eyesores and problem spots (not only not a 

NIMBY response, but a warm welcome), and participants in homeless job training programs 

gain construction skills as well as a sense of ownership as they prepare the housing for 

occupancy-perhaps by themselves. 

State Funding 

California and Massachusetts have extensive state funding programs for homeless-related 

programs and services and affordable housing. Ohio, Pennsylvania, and Washington have less 

extensive state funding but still have some state-level resources used by providers in the 

communities we visited. 

California 

AB 2034. California has a unique source of funding for homeless people, probationers, and 

parolees experiencing serious mental illness (Mayberg, 2002). Funding is authorized through 

Assembly Bills (AB) 34 (for the pilot year) and 2034 (for the fust year of full funding) and is 

referred to as the AB 2034 program. The Department of Mental Health (DMH), Adult Systems 

of Care administers this program to provide community mental health services and outreach to 

mentally ill adults and transition-age adults who are homeless or at risk of homelessness, with 

the intention of preventing or ending their homelessness. In addition to homelessness, this 

population often experiences costly incarcerations and hospitalizations because their needs are 

not addressed until they are in crisis. 

AB 2034 programs participate in a mandatory statewide evaluation that documents their impact. 

Statewide, the program has reduced hospitalization experiences; client data show a 66 percent 

decrease in hospitalization days statewide from the 12 months before to the 12 months after AB 

2034 enrollment. Findings also show that about 60 percent of the clients are dealing with 

substance abuse issues in addition to mental illness and that once enrolled about 84 percent of 

clients continue in the program. Participation in AB 2034 services has reduced incarceration 

experiences, including the number of unduplicated clients who become incarcerated, the number 

of incarcerations overall, and the number of days incarcerated (82 percent fewer incarceration 

days statewide in the 12 months following enrollment compared to the preceding 12 months). 

As of the 2002 report, California has spent $55 million overall on the AB 2034 program, or 

$13,000 annually per client statewide, meeting about 10 percent of the need according to county 

informants. This expenditure has been offset by $23 million in cost savings as a result of reduced 

inpatient hospital stays and reduced incarcerations. Two cities we visited have AB 2034 

programs-Los Angeles and San Diego. 

Other California funding streams. California has several other important state programs that 

communities use to fund programs to end chronic street homelessness and to create affordable 

housing. These include (Corporation for Supportive Housing, 2001): 

• 	 Supportive Housing Initiative Act (SHIA). SHIA, a program of the Department of Mental 

Health, encourages development of permanent, affordable housing with supportive 

66 
Chapter 6: How Communities Pay for Their New Approaches 

services that enables low-income Californians with disabilities to stabilize their lives. It 

covers services and operating costs (through rent subsidies) in supportive housing. 

Funding was about $20 million a year, but renewal funds have not been available the past 

two years and many grants have expired .. It may become an important source of funding 

again when the state budget is not facing crisis deficits. 

• 	 Multifamily Housing Program (MHP). MHP, a program of the Department of Housing 

and Community Development, provided streamlined, omnibus permanent financing 

program for affordable multifamily housing development for special needs and disabled 

households, including homeless persons or persons at risk of becoming homeless. It 

provides low-interest loans to developers of affordable housing for new construction, 

rehabilitation, acquisition and rehabilitation, or conversion of nonresidential structures. 

Rent write-downs may be added in future years. Passage of Proposition 46 in California 

in November 2002 created a special Supportive Housing Program under MHP, which is 

for homeless or at-risk households with a disabled adult member. The funds total $190 

million available over 3 years. Proposition 46 also expanded the amount of funding for 

the General Program to $770 million over 4 years. 

• 	 Special Needs Affordable Housing Lending Program. This program, under the California 

Housing Finance Agency, Multifamily Programs section, is designed to serve special 

needs populations by reducing interest rates (to 3 or 1 percent, depending on tenant 

targeting) on multifamily loan products to develop projects that serve low-income 

disabled tenants in need of special services to create stable, long-term supportive housing 

environments. 

• 	 Emergency Housing Assistance Program (EHAP). A program of the Department of 

Housing and Community Development since 1993, EHAP funds emergency shelter, 

transitional housing, and services for homeless individuals and families, including safe 

haven/low demand programs. Funds are distributed to all counties based on a formula 

that combines poverty and unemployment statistics. Funding fluctuates, usually between 

$10 and $20 million a year. 

• 	 Low-Income Housing Tax Credits (LIHTC). California augments Federal LIHTC with its 

own program to encourage private investment in affordable rental housing. The state 

program supplements Federal tax credits in projects that are eligible for them. In 2002 

state funds were actually greater than Federal funds--about $70 million added to the 

Federal $59 million. 

Other State Funding Streams 

Other sites we visited also have significant sources of state support. Boston has substantial state 

funding for homeless services. Massachusetts' Departments of Public Health and Mental Health 

combined invested about $31 million of mainstream funding to services for the chronically street 

homeless popUlation. Philadelphia receives support from Pennsylvania's Homeless Assistance 

Program, mostly for families and thus not particularly useful for the street homeless popUlation 

that is the focus of this report. The Washington State Housing Trust Fund and the Washington 

State Housing Finance Commission (tax credits for constructing transitional housing), provide 

67 

Chapter 6: How Communities Pay for Their New Approaches 

funding support for emergency shelter and transitional housing acquisition, rehabilitation, and 

construction in Seattle. 

Federal Funding Other Than McKinney 

Programs funded through the McKinney-Vento Act are the most common Federal funding 

sources for the agencies serving the chronic street homeless population. McKinney programs 

administered by HUD suppurt emergency services and transitional and permanent supportive 

housing. Programs funding emergency services include the Emergency Shelter Grants program 

(which HUD distributes by formula to eligible jurisdictions) and the Emergency Food and 

Shelter Program (which a special board of the Federal Emergency Management Agency 

distributes by formula to eligible jurisdictions). Several funding streams support transitional and 

permanent supportive housing, including the Supportive Housing Program (transitional and 

permanent), Shelter Plus Care (permanent), and Section 8 Moderate Rehabilitation SRO. Other 

large McKinney programs include Health Care for the Homeless (administered by the Health 

Services Research Administration within DHHS), Projects for Assistance in Transition from 

Homelessness (administered by the Center for Mental Health Services within DHHS), education 

for homeless children (administered by the Department of Education), and several programs for 

homeless veterans (administered by the Department of Veterans Affairs. From time to time, 

McKinney has also included other programs and special research and demonstration projects. 

While most homeless assistance providers and planners are aware of the homeless-specific 

funding streams included in McKinney, the communities we visited also used many other 

Federal sources of funding that might not be so obvious to other communities. Table 6.1 shows 

all the Federal funding streams appropriate to the task of reducing or ending chronic street 

homelessness that are used for that purpose by the communities we visited. 

A number of communities use various block grants-including Community Development, 

Mental Health, Substance Abuse, and Preventive Health-to support housing and services for 

chronically street homeless individuals. Using Seattle as an example, King County uses CDBG 

funding to acquire and rehabilitate rental units for homeless persons. Seattle uses CDBG funding 

to operate emergency shelter, transitional housings, and daylhygiene centers. The city also uses 

MHBG funds to administer involuntary treatment to clients who have included an unknown 

number of homeless individuals. In 2003 MHBG funds will also be used to fund HOST (an 

outreach program for street homeless individuals) and the Crisis Triage Unit in Harborview 

Medical Center Emergency Room. King County uses SABG funds to support county services to 

homeless individuals, including the Emergency Services Patrol that provides chronic public 

inebriates with transportation to the Sobering Center or the Crisis Triage Unit. Also, both Seattle 

and Philadelphia were part of the ACCESS demonstration program for homeless services 

through the Substance Abuse and Mental Health Services Administration, Center for Mental 

Health Services (DHHS). 

The Veterans Affairs Greater Los Angeles Healthcare System's collaborative network of 

services uses a number of Federal funding streams to fmance its work. Many of the communitybased organizations that are part of the network receive funding through the VA's Grant & Per 

Diem program. Each partner agency applies directly to the VA for the grant. 

68 
Chapter 6: How Communities Pay for Their New Approaches 

Table 6.1: 

Federal Sources Invested in Ending Street Homelessness 

Site Visit Cities 

Type of Investment Birmingham Boston Columbus 	 Philadel- San Seattle 

phia- Diego 

McKinney-FEMA X X X X 

McKinney-ESG X X X X X X 

McKinney-SHP X X X X X X 

McKinney-S+C X X X X X X 

McKinney-SRO Mod Rehab X X X 

HOPWA X X X X X X 

HOPE VI-relocation and 

supportive services 

HOME X X X X X X 

Section 811 

Section 202 

Public housing units X X X 

Section 8 (other than S+C) X X X X X X 

Moving-to-Work (PHAs) X 

CDBG X X X X X X 

LlHTC X X X X X 

Federal Home Loan Bank X X X 

TANF-Services or MOE X X X 

SSBG X 

MHBG X X X X 

PATH X X X X 

SABG X X X X 

Preventive Health BG 

Health Care/Homeless X X X X X X 

Medicaid X X X X X 

Medicare 

Workforce Investment Act X 

(WIA-DOL) 

Homeless Veterans X X 

Reintegration Project (DOL) 

Department of Veterans Affairs X X X X X 

Note: Funding information is not included for Los Angeles because no central system was studied. 

The network also takes advantage of funding from the HUD-VA partnership known has HUDVASH (VA Supported Housing). These funding sources do not appear in Table 6.1 because we 

did not do a funding table for Los Angeles as a whole. However, other communities should know 

about funding opportunities for homeless veterans available through the Department of Veterans 

Affairs. 

One Birmingham provider gets loans through the Federal Home Loan Bank to renovate 


structures to create transitional and permanent supportive housing, and affordable housing 


without supportive services. Boston providers have also used this source of capital funds. 


69 

Chapter 6: How Conununities Pay for Their New Approaches 

Five rows in the table have no entries: HOPE VI, Section 202, Section 811, Preventive Health 

BG, and Medicare. Although none of the communities reported using them, these are programs 

that can be used, and we are leaving them in to draw attention to their potential contributions. 

Self Support 

Some programs use client contributions to fund aspects of their services or housing. Programs 

with particular focuses onjob readiness, training, and employment, usually for recovering 

substance abusers, require client contributions of some sort once the person is employed. For 

example, all of the agencies in Birmingham offering shelter and housing use client wages for rent 

once the client has a job, and the programs work very hard to get people ready for work and help 

them find jobs. Providers say they have little trouble placing people in employment, and have a 

large network ofjob opportunities because they cultivate employers. Rents for emergency shelter 

are relatively low, but for transitional housing they come close to market rate, in part because 

there are few alternative sources of housing support, and in part because tenants are ultimately 

expected to become independent and conditions in transitional programs are set to create 

incentives for them to do so. In Los Angeles, tenants in the Westside Residence Hall (a partner in 

the Veterans Affairs Greater Los Angeles Healthcare System collaborative network) also pay 

rent if employed. 

Funds Blending and Access 

One of the biggest problems for homeless assistance providers is assembling the funds to be able 

to offer all the various services that chronically street homeless people with disabilities are likely 

to need. Few funders cover-them all, so the challenge for providers is to keep track ofwhich 

sources will fund what, when one needs to apply for them, who is eligible for services from 

particular funding streams, and who has time to do the applications. People at every level of 

government and service provider talk about "funding silos" and "categorical funding" that 

inhibits getting clients what they need. It is no wonder that providers value funding programs 

such as California's AB 2034, which can fund "whatever it takes" to end homelessness and 

prevent its recurrence. For homeless consumers, blended funding is also a boon. We highlight 

several approaches to providing wrap-around services through creative funding "funnels" at the 

consumer level. 

Blending Fundingfrom the Provider Perspective 

In the absence of universal programs such as AB 2034, some communities have developed 

mechanisms that reduce the burden on providers by streamlining the funding acquisition process. 

We call these "funnel mechanisms" because, in theory at least, all the funding sources go in at 

the top, get blended, and come out at the bottom in single grants to providers to cover their 

program requirements. We found several examples of funnel mechanisms in the communities we 

visited, ranging from single requests for proposals (RFPs that offer blended funding from several 

agencies, arranged through memoranda of understanding among the funders) to routine funneling 

activity. 

70 
Chapter 6: How Communities Pay for Their New Approaches 

One-Time RFP. Agencies in San Diego are working to increase access to funding resources for 

homeless service providers by blending different funding sources. In 2002, the Centre City 

Development Corporation, the City of San Diego, Corporation for Supportive Housing, County 

of San Diego, and the San Diego Housing Commission (the city's public housing authority) 

developed a memorandum of understanding among themselves outlining resource and other 

commitments, and issued a first-ever joint request for proposals. This RFP "To Develop and 

Operate Transitional and Permanent Supportive Housing Facilities in the City of San Diego for 

Homeless Adults with Serious Mental Illness or Dual Diagnosis" invited qualified housing 

developers, nonprofit organizations, property owners, and development teams to submit 

proposals to create more supportive housing, representing a key strategic initiative for achieving 

the goals of creating 100 new transitional and 100 new permanent supportive housing units in the 

next several years. As a result, providers only have to submit one grant response to access all the 

above sources of money, making it easier and less costly to write proposals. Respondents felt 

that this blended approach was the best way to get proposals for programs that meet their 

requirements for ending chronic street homelessness, and anticipate repeating the process as 

funding permits. In the end the joint RFP was able to fund additional transitional units through 

Vietnam Veterans of San Diego, but did not result in the development of any additional 

permanent supportive housing units. However, the RFP did provide a model for future 

collaborative housing projects. 

Stable Funnel Mechanisms. Both Columbus and Philadelphia have stable funnel mechanisms to 

make providers' lives easier. 

Columbus 

Rebuilding Lives is Columbus' integrated approach for moving chronically street homeless 

people to housing. As described in Chapter 4, resources for Rebuilding Lives are managed by a 

specially created "Funder Collaborative" that helps funders meet mutual goals as well as 

smoothing resource acquisition for providers. Members of the Funder Collaborative include the 

Community Shelter Board (which oversees the implementation of Rebuilding Lives, chairs the 

Funder Collaborative, and serves as the main fiscal agent for the initiative), the Alcohol, Drug, 

and Mental Health Board of Franklin County (ADAMH), City of Columbus Administration, 

Columbus City Council, Columbus Foundation, Columbus Health Department, Columbus 

Mayor's Office, Columbus Medical Association Foundation, Columbus Metropolitan Housing 

Authority, Corporation for Supportive Housing, Franklin County Department of Job & Family 

Services, Franklin County "MRJDD, Franklin County Administration, Franklin County Office on 

Aging, Mid-Ohio Regional Planning Commission, Ohio Capital Corporation for Housing, United 

Way of Central Ohio, and the Veterans' Service Commission. Since Rebuilding Lives was 

launched, the Funder Collaborative has met monthly and now meets every other month to 

address funding and system issues-serving as the main mechanism for coordinating and 

monitoring the system. 

Providers apply to CSB for a whole project, indicating the types of services and housing for 

which they need funding. CSB funds a project as a whole, funneling the money it receives from 

the sources described above in response to provider proposals and specifying reporting 

requirements. Projects may also receive direct funding through HUD's Supportive Housing 

Program, a small share of state dollars, and other funds. For the current year, the Rebuilding 

Lives budget is $5 million, most of which is for permanent supportive housing. Major funders 

71 

Chapter 6: How Communities Pay for Their New Approaches 

are the Franklin County Board of Commissioners, the City of Columbus, and the United Way of 

Central Ohio. 

CSB does not fund capital grants but it does help agencies secure such grants. Now that it has a 

better sense of the actual costs of permanent supportive housing, it is better able to predict the 

financial needs of a project (and operational and service costs have to be renewable). The costs 

are about $14,000 per unit per year for operations (mostly rent) and services. 

HUD dollars are the primary Federal dollars used to support Rebuilding Lives. There are no real 

restrictions on them other than to use them for supportive housing; "they are flexible and we can 

use them well" says CSB's directoL There are some challenges associated with Federal 

guidelines passed within the last several years, such as tenants not baving any prior felony 

convictions; CSB is still working on resolving these kinds of barriers to housing. Although each 

PHA uses the same Federal guidelines, they are just guidelines and each PHA can choose 

whether to embrace, weaken, strength, or enforce those guidelines. 

P hilade lphia 

In Philadelphia, staff members at city offices combine local money with Federal and state money 

to address the needs of chronically street homeless individuals. Homeless assistance programs 

fall primarily under the responsibility of the city's Offices of Housing and Community 

Development and Adult Services (OHCD and AS). OHCD receives ESG, CDBG, HOPWA, and 

other Federal resources, and conducts the annual Consolidated Plan process. It funds some 

transitional housing directly, and transfers Federal resources to AS for funding emergency 

shelter and additional transitional housing. City, state (Homeless Assistance Program), and 

Federal funds flow through AS and its component parts, the Office of Emergency Shelter and 

Services, the newly created Housing Support Center, Riverview Home (a city-owned personal 

care residence for elderly and/or vulnerable Philadelphians) and the Office ofHIV Planning (a 

body responsible for coordinated planning for Federal funding from the Centers for Disease 

Control and Ryan White Title I). AS is also the City's convener for the annual Continuum of 

Care application. Some other agencies-Office of Mental Health, the Coordinating Office of 

Drug and Alcohol Abuse Programs, and the Department of Hwnan Services (the child welfare 

office}-maintain small numbers of units that are closer to "housing plus services" than to 

treatment, and which accept homeless people as residents. 

Philadelphia also combined the resources of social services with housing monies to create a stock 

of permanent supportive housing before homeless-specific Federal funding was available. In the 

early 1990s, the director of OHCD conunitted his agency to supplying housing in cases where 

the social services side of city government could and did supply the supportive services. At that 

time, Philadelphia had underspent its CDBG allotment for a number of years, so that money was 

made available to support transitional and permanent housing development. 

Agencies As Funding Funnels to Ease Client Access to Services 

As difficult as it is for agencies to assemble adequate funding to cover all their offerings, 

homeless people themselves often have an equally or more difficult time putting together the 

care they need. Conflicting eligibility criteria, lengthy application procedures, dispersed service 

72 
Chapter 6: How Communities Pay for Their New Approaches 

locations, and simple ignorance about options and opportunities often mean that chronically 

homeless people do not get the services and supports that could help them leave homelessness. 

"Case management," (which may mean a variety of things in different contexts) is often 

expected to help clients overcome these obstacles to getting appropriate services, and often it 

does just that. Case managers in most communities use their skills to broker the disparate 

services and programs that may be involved in aiding an individual homeless person. In our site 

visits we encountered some examples of "next steps" beyond simple case management that had 

decided advantages for clients-programs that within themselves combine enough varieties of 

funding, to cover enough varieties of supports, that they can "do whatever it takes" to help the 

client. They also had the accounting and fiscal sophistication to bill the appropriate funding 

sources without the client having to worry about eligibility. We found two forms of "funnel 

mechanisms" at the client level- mini-continuums and non-residential wraparound programs. 

Mini-continuums. Mini-continuums bear mention here for their particular approach to funneling 

support to clients. The umbrella agency for a mini-continuum takes pains to acquire funding 

from many sources so that regardless of client characteristics every client is able to receive all 

the services offered. Clients are usually unaware of the funding sources for the services they 

receive. They may know that the agency is trying to help them obtain SSI, or Medicaid, or 

transitional cash benefits, but they also know that they will receive services whether or not they 

end up qualifying for these programs. Agency staff members offer clients whatever services they 

need, and then detennine how to report service numbers and bill their funders. For example, the 

Lamp Community in Los Angeles receives a certain amount ofAB 2034 money to serve clients 

coming from jail. However, the program continues to serve these clients once they have reached 

the "capacity" allowed under AB 2034 funds. All clients in the Lamp Community are offered 

available services as needed. Other examples of agencies that blend funding streams to serve 

clients comprehensively are Pine Street Inn and Friends of Shattuck Shelter in Boston, and 

several mini-continuums in Seattle. 

A final example is Birmingham Health Care (BHC), which we highlight because it is quite 

unusual to fmd a full mini-continuum growing out of a program that began as a Health Care for 

the Homeless site. BHC's continuum begins with prevention, as its health clinics serve lowincome communities generally, as well as homeless people. All people using BHC clinics are 

screened for housing needs, and referrals are made as needed. BHC has emergency shelter 

capacity in the form of hotel/motel vouchers, and also operates transitional and permanent 

supportive housing programs. Its fully certified health provider status means it has the ability to 

offer, and integrate, health, mental health, substance abuse, IDV/AIDS, and housing programs 

and services. BHC maintains one integrated client file across all programs and services, 

reinforcing to its employees the message that they are to consider, and work with, the whole 

person regardless of the "presenting problem." 

"Whatever it takes" case management. Two of San Diego 's most important programs focused 

on chronic street homeless people use an interesting approach to delivering supportive services 

to keep people in housing-they contract with behavioral health companies, one for-profit and 

one nonprofit. REACH contracts with Telecare Corporation for mental health case management, 

while Mental Health Systems, Inc. provides assessment, case management, and substance abuse 

and mental health services for SIP participants. REACH Program participants may also access 

other providers for a variety of services through their case manager. These companies are able to 

73 

Chapter 6: How Communities Pay for Their New Approaches 

deliver appropriate care with workers who often are dual-certified for mental health and 

substance abuse treatment and have experience with people coming from corrections settings. 

They are also sophisticated enough to handle Medicaid claims (Medi-Cal in California), and are 

able to fmance a significant portion of the services they provide through Medi-Cal billing, after 

helping clients qualify for SSI and Medi-Cal. The more Medi-Cal pays for the services it will 

cover, the more program service dollars can be devoted to other service needs. These companies 

also have county contracts for health, mental health, and substance abuse care, and thus are able 

to serve clients as needed and bill whichever source will pay, without troubling the clients about 

multiple program eligibility rules, applications, and so on. In addition to these advantages of 

contracted behavioral health services, the REACH program has succeeded in increasing to 85 

percent (from about 15 percent) the people receiving cash and other public benefits (usually 

health insurance, food stamps, SSI, and other cash assistance). As with expanded Medicaid 

billing, increased client receipt of public benefits increases the overall resources available to help 

them remain stably housed. 

For this approach to work, clients must have housing from another source, as they do in San 

Diego. The case management agencies must also have multiple sources of funding, including 

some that will let them serve indigents without other insurance. In the San Diego case both 

agencies have service contracts with the county Mental Health Services agency to provide 

mental health and substance abuse services. While these case management agencies do connect 

clients to specialty services outside their areas of expertise when needed (e.g., to job readiness 

and training opportunities), they are able to supply the core health, mental health, and substance 

abuse services within their own framework and in partnership with the clients' housing 

providers. 

Potentially U nderused Funding Opportunities 

The Ohio program office of the Corporation for Supportive Housing assembled a list of funding 

sources that she felt were underused in Columbus (Community Shelter Board, 2003). Columbus 

does use some of these, as do others of the communities we visited. As the list is likely to be 

interesting to many readers, we reproduce it here as Table 6.2; we have added a few potential 

sources, which appear in italics. The list includes state and local as well as Federal sources. To 

the extent that a state and community does not have particular types of funding, the list may also 

serve as a source of ideas for stimulating the creation of new state and local funding sources. 

Finding the resources to pay for new programs and services is always a challenge. The 

experience of these seven communities indicates very strongly that reducing chronic street 

homelessness requires significant investment of mainstream public agencies, bringing both their 

commitment and energy, and local dollars. The goal cannot be met if the homeless assistance 

network providers are the only players, and Federal funding streams the only resources. 

Communities are probably most familiar with the traditional Federal sources of funding for 

homeless-related activities, but as this chapter shows, more Federal sources exist than some may 

think. Perhaps even more important for many readers are the different funding sources that some 

state or local jurisdictions have developed to address chronic homelessness. These include a 

housing tax levy (Seattle), tax increment fmancing generated by a redevelopment agency and 

reinvested in permanent supportive housing (San Diego), community redevelopment bonds 

74 

Chapter 6: How Commuruties Pay for Their New Approaches 

Table 6.2: 

Potentially Underused Funding Sources For Ending Chronic Street Homelessness 

Capital Sources 

• 	 Department of Veterans Affairs - Capital grants for Veterans projects. 

• 	 Federal Home Loan Bank - Affordable housing development grants. 

• 	 HUD Section 811 - Use is for disabled, very low income; has experienced significant funding cutbacks 

in recent years. 

• 	 HUD Section 202 - Use is for seniors, very low income. 

• 	 Community-Development Block Grant-states have flexibility to use for capital needs. 

• 	 State Housing Trust Fund - Gap funding for affordable housing projects. 

• 	 City/County Housing Trust Fund - Bridge loans for affordable housing projects. 

• 	 State Bond Funds - Long-term financing. 

• 	 State or Local Housing Finance Agency-long-term, low-interest financing. 

• 	 State General Funds - Ohio Department of Mental Health grants for mentally disabled housing 

development. 

Sources for Supportive Housing Operating Costs 

• 	 State General Funds - Ohio Department of Mental Health and Ohio Department of Alcohol and Drug 

Addiction Services grants for operating. 

• 	 State Housing Trust Fund - Operating grants for affordable housing «35% area median income). 

• 	 HUD HOPWA (Housing Opportunities for People with AIDS) - Operating grants for AIDS/HIV. 

• 	 HUD Section 202 - Provides rental subsidies through 5-year contracts. 

• 	 HUD Section 811 - Provides rental subsidies through 5-year contracts; program has had major 

cutbacks. 

• 	 Capitalized Reserves - Legal agreements needed; source of funds are Low Income Housing Tax 

Credit investment proceeds, Community Development Block Grant, HUD Section 811, Housing Trust 

Funds or other local General Revenue which are not statutorily or legally prohibited. 

• 	 Special state-funded supportive housing demonstrations - Have been successful in other states like 

Michigan, Minnesota, Illinois, and Connecticut. 

Sources for Services 

• 	 HUD HOPWA (Housing Opportunities for People with AIDS) - Provides services for people with 

AIDS/HIV. 

• 	 Federal SAMHSA (Substance Abuse & Mental Health Services Administration) - programmatic grants. 

• 	 Federal PATH (Projects for Assistance in Transition from Homelessness) - Provides services for 

people with mental illness. 

• 	 "System of Care" models have been successful in Indianapolis, Minnesota and California. 

• 	 Medicaid and Medicaid Waiver programs, including Medical Rehabilitation Option - A local Medicaid 

Work Group continues to evaluate how best to use this as a source. 

• 	 SSIISSDI - Payments, when appropriate, can be paid directly to the housing or service provider; can 

offset the cost of services. 

• 	 Federal Block Grants-Social Services, Menta/ Health, Substance Abuse, Preventive Health, 

Community Services - States have flexibility to determine services delivered, eligibility, and distribution 

method. 

• 	 Federal, state & county criminal justice systems - Have been successful in Illinois and New York. 

• 	 Special state funded supportive housing demonstrations - Have been successful in other states. 

• 	 State Housing Trust Funds - Could be a resource if OHTF has stable and growing source of revenue. 

75 

Chapter 6: How Communities Pay for Their New Approaches 

(Philadelphia), special state funding streams (California's Integrated Services for Homeless 

People with Mental Illness, and its Supportive Housing Initiative Act), and investments by 

Business Improvement Districts and other associations of downtown businesses and corporations 

(Birmingham, Columbus, Philadelphia, San Diego). Philadelphia's Community Behavioral 

Health also provides a unique source of public funding for homeless services. Part of its structure 

to insurers, including Medicaid, that help pay for services is a "profit" margin. As a city agency, 

it is committed to investing a part of this "profit" margin into homeless assistance services such 

as outreach that are not reimbursable on a fee-for-services basis, and in housing. Other states 3.'1d 

localities may be more willing to replicate these funding sources once policy makers have 

evidence that making certain types of investment in ending chronic street homelessness pays off 

in savings in other areas. 

76 

CHAPTER 7: POLICY, PRACTICE, AND RESEARCH IMPLICATIONS 

This is a time when communities are exploring new approaches to end chronic street 

homelessness. Realistically, the approaches are still at the stage of reducing such homelessness, 

and the evaluations of their success are still rudimentary. We selected seven communities that 

were reputed to have made progress in reducing their chronic street homeless population and 

would be able to document that progress. After conducting site visits, we found that only three of 

the seven had developed a true comInunity-wide paradigm, but that each-of the seven 

communities had made noteworthy innovations at the strategic level. Our research suggests that 

certain elements are essential for a community to make significant progress toward the goal of 

ending homelessness. 

Above all our study indicates that reducing, and eventually ending, chronic homelessness is an 

achievable goal that will require permanent supportive housing programs. Moreover success will 

require a clear recognition of this goal, community-wide collaboration, strong leadership within 

an effective organizational structure, and significant resources from mainstream public agencies. 

Other elements that will increase the likelihood of success are significant resources from the 

private sector, commitment and support from elected officials, outcome evaluation mechanisms 

for program support and improvement, openness to new service approaches, and strategies to 

minimize negative neighborhood reactions to projects. In this chapter we explore the 

implications of these findings. 

Implications for Policy 

Our study has found that the most successful communities were employing community-wide, 

integrated approaches to reduce chronic homelessness. However, such approaches were not 

widespread. We searched for communities meeting these criteria and only found three. The 

scarcity of exemplary sites suggests that the effectiveness of community-wide, integrated 

approaches needs to be publicized. Communities also need assistance in recognizing and 

implementing the elements necessary for success, and funding support from Federal, state, and 

local agencies that is directed toward these new strategies. 

During site visits many respondents offered suggestions for how Federal policy and Federal 

agencies could help them as they pursue their goal of ending chronic homelessness. Their 

suggestions reflect their own experiences of what has helped them, and also what they feel could 

continue to ease the way toward reaching their goal. These include suggestions for Federal, state, 

and local agencies. A particular problem for communities was that diverse, uncoordinated 

funding streams required them to submit numerous proposals to many different agencies in order 

to provide total wraparound housing and supportive services for the chronically homeless. The 

policy implications of these findings are: 

• 	 Federal agencies should continue to prioritize community-wide planning and integrated 

approaches for reducing chronic homelessness in general, and street homelessness for 

people with severe mental illness, chronic substance abuse, mY/AIDS, or any 

combination in particular. 

77 
Chapter 7: Policy, Practice and Research Implications 

• 	 Federal agencies should make technical assistance widely available to teams from 

communities that have reached the stage of starting to plan an approach to reducing street 

homelessness. 

• 	 Federal agencies should facilitate opportunities for practitioners and planners to observe 

new approaches in action, speak with consumers, see results, and consider how these 

practices could be applied in their own community. 

• 	 Federal legislative action should increase the flexibility of Federal agencies to blend their 

funding to support innovative community-wide practices that integrate services across 

local agencies to reduce chronic homelessness. State and local agencies should adjust 

rules and regulations to facilitate access to mainstream benefits, programs, and services 

for chronically street homeless people. 

• 	 State and local agencies should establish procedures and resources to assure that people 

leaving psychiatric care, substance abuse treatment, correctional facilities, or foster care 

do not become homeless. 

• 	 State and local agencies should facilitate capacity to serve chronically homeless clients 

by improving liaison and integrated service arrangements among mental health, 

substance abuse, medical care, and housing authorities. 

Implications for Practice 

The site appendices of this report include "practices of potential interest to other communities" 

with contact information for people who are involved in these activities. Readers should browse 

these practices to see whether any of them might be appropriate for their own community. There 

are, however, some general implications for practice. To successfully reduce chronic 

homelessness within a community: 

• 	 Homeless providers need to develop dual competence and dual certification-mental 

illness and substance abuse issues must be handled together. 

• 	 Mainstream mental health and substance abuse agencies need to have an integrated 

approach to mental illness and substance abuse for chronically street homeless people. 

• 	 Mainstream health, mental health, substance abuse, and welfare agencies should make 

their clients' housing stability a high priority and create positions of housing developers 

and coordinators. 

• 	 Housing providers need to understand the benefits of supportive services to their whole 

tenant base and not just to those who were once homeless. 

• 	 Strong, skilled leaders committed to an integrated community-wide approach need to 

come forward and have the backing and resources of local mainstream agencies and 

elected officials. 

78 
Chapter 7: Policy, Practice and Research Implications 

Implications for Research 

Although the study communities were documenting the "success" of their approaches, research 

on the outcomes and the cost effectiveness of their various strategies often had flaws in design or 

incomplete data. We discovered many gaps in knowledge that hindered our ability to establish 

with greater confidence which approaches and strategies were·most fruitful and hold the most 

promise for other communities. The following research suggestions are those that we think will 

provide the most useful information to show effective approaches to ending chronic street 

homelessness. 

• 	 Longitudinal tracking studies should follow people once they leave supported housing to 

document housing stability. A primary outcome to observe in this research would be 

housing stability within and after leaving the homeless assistance network, and what 

factors contribute to it. These studies would be most relevant to conduct for formerly 

street homeless people with severe mental illness and co-occurring disorders. 

• 	 Research should compare the effectiveness and cost-effectiveness of different pathways 

into permanent housing for different subpopulations. Ideally this research would use 

random assignment intervention studies; if that is impossible, it must employ meaningful 

companson groups. 

• 	 Research on pathways should include (1) directly from the street into permanent 

supportive housing, (2) directly from the street into transitional housing as a step before 

permanent supportive housing, (3) directly from the street into safe haven as a step before 

permanent supportive housing, and (4) transitional housing with expectation of 

movement into affordable housing in the community (no supportive services). 

• 	 Research should test the following approaches within the pathways just described (1) 

sober versus harm reduction models, (2) voluntary versus coerced treatment (the latter 

through drug court or its equivalent), (3) different physical structures and service delivery 

mechanisms (for example, scattered site, only-formerly-homeless single site, and mixeduse single site), and (4) if transitional housing is part of the pathway being tested, what is 

the optimal duration of transitional housing to increase the odds of maintaining recovery. 

• 	 Research should support a reasonable sample of permanent supportive housing providers 

to collect and maintain better data on their tenants, and assemble these data at the national 

level. The providers would need to collect data (1) at intake about tenant histories, (2) 

during residence, and (3) after people leave permanent supportive housing, to document 

continued progress or return to homelessness. To give this approach the greatest chance 

to contribute high quality information, a national research effort would have to be 

established to manage data collection within programs and conduct the follow-up 

interviewing, if one wanted to assure acceptable completion levels. 

79 

Appendix A: Birmingham 

Primary Contact Person 

Michelle Farley 

Interim Director of Metropolitan Birmingham Services for the Homeless 

Metropolitan Birmingham Services for the Homeless 

2230 4th Avenue North 

Birmingham, AL 35203 

Phone: 205.254.8833 

Fax: 205.323.8362 

mmfarley2003@yahoo.com 

History and Context-How the Current System Evolved 

Birmingham's array of programs and services for chronically street homeless adults emerged 

piecemeal over the years, despite some early efforts to focus on street homelessness. About five 

years ago a Mayor's Task Force was assembled to address street homelessness in response to a 

city council member's proposal of an ordinance to outlaw "urban camping." The ordinance 

suggestion was roundly denounced, but all of the organizations working with street homeless 

people assembled as a task force to figure out how to help people leave the streets. It evolved 

four goals: (1) getting more professional staff in shelters; (2) developing more beds so the wait 

was not so long for substance abuse treatment; (3) starting a women's program (First Light); and 

(4) allowing the Birmingham Housing Authority to use some of its many vacant units for 

transitional housing. HUD vetoed the last of these proposals, and lack of funding meant that 

most of the remainder did not happen, at least at that time. 

One result of the Task Force was that programs got to know each others' services better, which 

facilitated access to services for the residents of individual programs. Another result was that the 

Mayor's Task Force gave some impetus and leverage to some providers' plans to expand their 

programs into transitional and permanent housing. For instance, CDM was able to fulfill one of 

its own goals to develop a transitional housing program when a property owner donated a 

building. CDM raised private money for renovations from the Birmingham Jaycees and the 

Community Foundation; other support came from CDM itself and from churches that sponsored 

apartment renovations at $2,000 to 3,000 an apartment. Men from CDM's Firehouse Shelter 

were trained and hired to do the renovation work. 

The Mayor's Task Force eventually blended into MBSH. Over the years, as different 

municipalities felt the need to have a plan related to homelessness, MBSH became the 

organization they all eventually sought out. Now Birmingham gives MBSH money to do its 

planning with respect to homeless issues, and the city is in the fourth year of a five-year plan 

developed through MBSH. The county's 30 mayors, 30 city councils, and the county 

commissioners have accepted that MBSH will be more successful at conceiving, developing, 

selling, and following through with a plan than they will themselves. They have, instead, 

become members of MBSH and work on homeless issues through the MBSH mechanism. 

While MBSH handles the overall planning and interagency communication in Birmingham, 

individual providers have been busy expanding their offerings relevant to chronic street homeless 

people. First Light and CDM's Firehouse have already been mentioned. Other providers that 

A.3 
Appendix A: Birmingham 

have expanded to provide both supportive housing (transitional and permanent) and "regular" 

affordable housing are Aletheia House and Birmingham Health Care. 

Aletheia House, a large substance abuse treatment provider, has developed hundreds of units of 

transitional housing to help its clients extend their sobriety in a stable housing environment. For 

the same reason and also because it recognized the need for affordable housing, Aletheia House 

has become theJargest developer of affordable rental housing (without services) in the 

Birmingham area. Its own (now self-supporting) clients can move into this housing, as can 

clients who will always need supportive services. Housing costs for the latter are subsidized by 

Shelter Plus Care and Section 8. 

Birmingham Health Care is another unique type of program. It is not often that an entire 

continuum of care springs out of a health care setting, but Birmingham has two examples in 

Aletheia House and BHC. BHC began as a Health Care for the Homeless site, and now offers 

physical health care, mental health and substance abuse treatment, transitional and permanent 

supportive housing, employment services, and integrated case management to chronically street 

homeless people along with other homeless and simply poor people through eight different 

clinics and health centers. 

The next section describes Birmingham's approach to ending chronic street homelessness in its 

downtown area, including documentation of progress to date. Thereafter we give more detail 

about selected system components, examine funding mechanisms, describe how the current 

system evolved and where it is going, and describe issues that have arisen with respect to 

community relations. 

Approach to Chronic Street Homelessness 

This section briefly describes the network of programs and services focused on reducing or 

ending chronic street homelessness among single adults. It also examines characteristics of 

people the system serves, how services are coordinated, and approaches or models in current and 

anticipated use. Continuum of care components addressing chronic street homelessness are 

described in more detail in the section entitled "Selected System Components," along with 

activities and investments related to increasing the stock of affordable housing. 

As already noted, MBSH is the key organization for homeless-related issues in Birmingham. It is 

an incorporated nonprofit with 50I(c)(3) status, but until September 2002 made do with one or 

more part-time employees. In September 2002 it hired its first full-time employee, someone with 

a fundraising background. Its membership is large and growing-an average of 40 agencies and 

organizations are usually represented at its monthly meetings, and the membership list is about 

twice as large. Participation in MBSH is completely voluntary and open to any organization or 

person interested in joining. Membership is eclectic and includes nonprofit and faith-based 

homeless assistance providers; business associations; housing developers, banks, and individual 

businesses; organizations representing people with various disabilities; representatives of city, 

county, regional, and Federal government agencies; elected officials; neighborhood associations; 

and formerly homeless individuals. 

AA 
Appendix A: Birmingham 

Birmingham did not have a specific focus on chronic homelessness or street homelessness until 

very recently. As recently as its 2.002 CoC application, presentations of its approach describe the 

community as trying to end all homelessness without distinguishing between chronic and crisis 

homelessness. Specific foci include gathering data to understand the scope of the problem and 

addressing the need for more affordable housing. The desire to respond to the Federal Chronic 

Homelessness Initiative Notice of Funds Availability (NOF A) in spring 2003 stimulated MBSH 

to focus on the chronically homeless population. All of the providers focusing on chronic street 

homelessness are members of MBSH, which will now have a specific chronic homeless ness 

subgroup that intends to meet monthly for the hour after the regular MBSH meetings. 

The MESH approach is to identify a problem and craft solutions through information sharing and 

discussion. In cases where funding is potentially available, MBSH tells all of its members of the 

opportunity and asks all interested parties to step forward. The results are usually that providers 

take stock of their capabilities and the direction they want their own agency to follow, look at 

who else might want to be involved, and sort themselves into reasonable combinations of 

applicants. This was the result recently in response to the Federal NOF A for the Chronic 

Homelessness Initiative, with a score of agencies expressing initial interest and three agencies 

plus MBSH being involved in the fmal proposal. 

Program and Service Network 

Birmingham has a number of agencies that offer emergency shelter to single homeless people. 

However, not all of these are involved in addressing chronic street homelessness. Table A.I 

shows the agencies with the strongest concentration of the street homeless population, including 

all that offer permanent supportive housing and/or transitional housing with follow-up services 

for people whose major issues are addiction-related. Rows represent different providers; columns 

represent the types of programs and services offered. An "X" in a cell indicates that the provider 

offers that program or service. An "F" indicates that a public agency funds a program or service, 

and an "E" indicates that the provider offers expert advice, technical assistance, or training. 3 

Three providers, BHC, CDM, and First Light, provide the broadest spectrum of programs and 

services for chronically street homeless single people. BHC does outreach, has vouchers for 

emergency/crisis housing in lieu of running an emergency shelter, has transitional and permanent 

supportive housing, and is a fully qualified primary health care, mental health care, and 

substance abuse treatment provider. CDM programs, which serve homeless men, range from 

outreach through PSH and will shortly include Birmingham's first safe haven for chronically 

homeless people with severe mental illness. First Light's programs, which serve homeless single 

women, include emergency shelter, transitional and permanent supportive housing, and mental 

health and substance abuse treatment. 

An important aspect of all the programs in Birmingham serving chronically street homeless 

people is their emphasis on employment. All have job training, job readiness, and job search 

components to their programs, and getting ajob is an expected and necessary part of many 

Table A.I does not represent the entire network of homeless assistance programs and services in Binningham. 

These and other providers may also offer programs and services for single people with brief homeless 

experiences, as well as homeless families with children and homeless youth. 

A.S 

3 
Appendix A: Birmingham 

programs' strategies for their residents. As soon as people have a job, they are expected to begin 

paying for the days they stay in the program, and also to open a savings account. Given the 

relatively low funding levels of the shelter and housing programs in Birmingham, this strategy is 

necessary to allow residents to remain in the programs as long as they need to, and to keep the 

programs functioning fmancially. Along with the work emphasis, a number of Birmingham 

programs also have a community service requirement-residents have to do 15 to 20 hours of 

community service a week. The rationale behind this requirement, and the effects that residents 

say it has on them, are described in more detail in the section on "Selected System Components." 

Involvement ofMainstream Agencies 

A few mainstream agencies play important roles in Birmingham's approach to chronic street 

homelessness, chief among which are JBS Mental Health/Mental Retardation (MH/MR) 

Authority, the Jefferson County Housing Authority, the Birmingham Department of Community 

Development, and the VA Medical Center. JBS has operated a homeless program for about 15 

years, staffed with its own employees and serving people with serious mental illness but without 

a permanent address or income. Services include mental health care and medications at a free 

clinic, conducting assessments at locations convenient for the people being assessed, and making 

referrals for housing, vocational rehabilitation, and transportation. JBS also covers supportive 

services for formerly homeless people with serious mental illness who live in PSH, including 

Shelter Plus Care. 

The Jefferson County Housing Authority and the Birmingham Department of Community 

Development both use a variety of Federal funding sources to support emergency shelters, 

transitional and permanent supportive housing, and to create affordable housing. The VA 

Medical Clinic serves veterans who are or have been homeless, offers services in some housing 

supported through Shelter Plus Care, and was a partner (with JBS and Birmingham Health Care) 

in Birmingham's application under the Federal Chronic Homelessness Initiative. 

Use ofPrivate Sector Resources 

Given the paucity of public funding for homeless programs and services in Birmingham, 

providers have developed a number of approaches that build on the resources and interests of the 

private sector. 

• 	 Donated buildings. Two agencies that develop transitional and permanent housing (with 

and without supports) have had success approaching owners of dilapidated and wholly or 

partially vacant properties to see if they will donate the property. If yes, the agencies use 

capital financing from the Federal Home Loan Bank and private lenders, plus Low 

Income Housing Tax Credits, HOME funds, and donations from religious congregations 

and private individuals to renovate and make repairs. The following benefits accrue: 

> Property owners get tax write-offs on properties that were losing money and 

causing problems; 

> 	 The agencies get free buildings they fix up and use; 

A.6 
Appendix A: Birmingham 

>-	 Neighborhoods get renovated and supervised buildings in place of eyesores and 

problem spots (not only not a NIMBY response, but a warm welcome); and_ 

>-	 Participants in agency job training programs gain construction skills as well as a 

sense of ownership as they prepare the housing for occupancy- perhaps by 

themselves. 

• 	 Employment focus for program participants. All of the agencies offering shelter or 

housing have job readiness, training, and placement services. They appear to be quite 

successful at moving people into employment, even while still in shelter or transitional 

housing. Once employed, residents' wages help fund the program through payment of 

rent. 

• 	 Private funding of HMIS. MBSH expects to be able to fund its HMIS through private 

donations, leaving all of the funding obtained through its CoC application for programs 

and services. 

Who Is Served? 

Chronically homeless street people with severe mental illness are served through JBS and 

various housing programs. If they have a co-occurring substance abuse disorder, however, JBS 

cannot address that issue, and can only refer clients to private substance abuse treatment 

programs. As we were told several times, the State of Alabama "considers substance abuse a 

choice," which means there is no public support, either fmancial or staff resources, for substance 

abuse treatment. Nevertheless, several programs specialize in helping chronic substance abusers 

with long histories of homelessness. They do this through highly structured treatment programs 

that have major components of community service and employment. Once residents are 

employed, their wages help to offset the cost of housing and continued program participation. 

A.7 

Appendix A: Birmingham 

Table A.1: City of Birmingham: Agencies Involved in Reducing/Ending Chronic Street Homelessne

Homeless-Related Programs and Services 

i;j d' :<: 

.1' 

·s ilf ::, &­ 0' .§ c:S is' :f .0<: :f t t rf 

CZ> /!! Q.CZ>f Q. d (jj 

Nonprofit Programs! Services! Agencies 

Serving Currently or Formerly Chronic 

Street Homeless People (listed 

alpha betica Ily) 

AIDS Alabama x x x X X X X X I E X 
Aletheia House x X X x I X I I X X I I X X X I E I I X 


Birmingham Health Care X X X XIXIXIX X I X I X X X I E I X I X 


Church of the Reconciler X X X 
Cooperative Downtown Ministries X x X X X I X X X X X X I E X 


First Light X X X XIX X X X X X X 


Metropolitan Birmingham Services to 
 X X X I E I X X the Homeless (MBSH) 

Pathways X X XIXIX X X X 

Business Associations 

City Action Partnership (CAP, X,F X X X X Birmingham's BID) 

Government Programs! Services! 

Agencies Serving Currently Fromerly 

Chronic Street Homeless People 

City Agencies 


Department of Community 
 F F F F F X F Development 

Police Department X X 

County Agencies 


Jefferson Co. Housing Authority F X X 


JBS MH!MR Authority X X X X F 


Community Development Department F F F F F 


VA Medical Center (federal) X X X I X I X I X X X X X 


X = Provider E =Expert TA Provider F = Funder 


In emergency situations, BHC uses vouchers to pay for hotel/motel stays, though it does not run an emergency shelter. 


.. COM is developing Birmingham's first safe haven , which is scheduled to open in December 2003. 


A.8 
Appendix A: Birmingham 

Coordination Mechanisms 

Planning and program development. MBSH is the key organization in Birmingham for 

homeless-related planning and program development. The organization was started in 1984 by a 

handful of homeless service providers, and became a tax-exempt nonprofit organization in 1988. 

As already noted, MBSH membership covers every possible type of organization, agency, 

business, and person interested in homeless people and solutions to homelessness in the greater 

Birmingham area, including representatives from neighboring city and county governments. 

Even when individual jurisdictions recognize the need to develop a plan and begin the process, 

people eventually say "why not go to MBSH with this, they'll know what to do." So they 

eventually come to MBSH and become members. This process of expanding membership has, 

over the years, made MBSH meetings the venue to learn about services, air concerns, discuss 

how to respond to everything from Federal NOFAs to local legislative issues, bring disparate 

interests together, and bridge communication gaps. 

MBSH also takes on tasks that affect many of its members. Developing the CoC plan and 

application is one of these, as was Birmingham's response to the recent Chronic Homelessness 

Initiative NOFA. MBSH is spearheading a drive to raise all the funding needed for an HMIS 

(estimated at about $500,000) from private sources, after membership decided that all the ffiJD 

funding through the CoC application was needed for programs and services. In addition, the 

missions that provide much of the emergency shelter in Birmingham are interested in 

participating in the HMIS, but would not do so if Federal monies were involved, as they do not 

accept any public money. The fact that MBSH appears likely to succeed in raising these HMIS 

funds attests to the linkages it has with the local business community and the level of agreement 

reached among members of both the need for an HMIS and the way they prefer to support one. 

Working with chronic street homeless people. While Birmingham has no formal coordination 

mechanism that helps case managers link chronically homeless people with services, linkages 

occur fairly smoothly because "we all know each other," in the words of many people 

interviewed. MBSH facilitates shared knowledge of the nature and availability of services 

through presentations at its monthly meetings. Different configurations of agencies work 

together to serve particular groups among chronically homeless people through co-location, joint 

teaming arrangements, and referral. For instance, First Light runs emergency shelter and 

transitional and permanent supportive housing for single women. JBS operates a clinic on the 

First Light premises where women can receive mental health and substance abuse services. A 

day program called PATH after its Federal funding source developed to complement First Light, 

and PATH merged with a domestic violence shelter program to become Pathways. First Light's 

women go to Pathways for lunch; Pathways guests come to First Light for counseling and 

therapy. JBS and First Light facilitate referrals to Shelter Plus Care and if the woman's mental 

illness is severe enough, JBS continues to provide supportive services. Another example of 

program linkages illustrates the ways that street homeless people may get into services-JBS and 

City Action Partnership (CAP, which is Birmingham's Business Improvement District), do street 

outreach, coordinate with each other, link street homeless people to CDM's Firehouse Shelter 

and to First Light, and work with those programs ' case managers. In addition, the Street 

Outreach Program (STOP) funded by ffiJD provides two CDM social workers to team with the 

CAP Patrol. Finally, the V A Medical Center, Jefferson County Housing Authority, and 

A.9 
Appendix A: Birmingham 

Birmingham Health Care worked together to develop the Chronic Homelessness Initiative 

application. 

Pathways to Housing, Approaches and Models 

• 	 Emergency shelter to transitional housing to housing. This is the pathway followed by 

most chronically homeless people whose primary issue is substance abuse. It is a "clean 

and sober" route involving 12-step meetings and other aspects of substance abuse 

treatment, community service, job readiness and subsequent employment, and eventual 

movement from transitional housing into regular market rate housing. Most of the 

people following this route are men. 

• 	 Outreach/drop-in and/or emergency shelter plus mental health services to PSH This 

appears to be the route most commonly taken by chronically homeless people for whom 

severe mental illness is the primary issue, most of whom are women. A medical or 

psychiatric contact is the first step, with emergency shelter a "holding" option until a 

PSH slot opens up either through Shelter Plus Care, other HUD-funded PSH projects, or 

within the mental health system itself. 

Selected System Components 

MBSH offers a common meeting ground for agencies focused on reducing the downtown 

chronic street homeless population. As Table A.l indicates, most of the agencies serving chronic 

street homeless people offer only a few aspects of a CoC, while a few offer a broad spectrum. 

Together these agencies include most of the usual CoC components. 

Several agencies within the system make outstanding contributions, because of the breadth or 

nature of their services. BHC provides free public meals; most types of housing (emergency 

shelter (ES) through hotel vouchers); especially strong and well integrated health, mental health 

and substance abuse services; employment training and on-the-job experience; advocacy for 

legislative programs; case management; cross-agency coordination of service delivery and 

planning; evaluation and planning data; and public relations and education. BHC is also an 

important research site for a National Institute on Drug Abuse study of substance abuse 

treatment. 

CDM also has a broad array of services, and makes a special contribution through its emergency 

shelter program which links to community outreach programs and provides temporary housing 

for clients ofBHC and other agencies. CDM uses BHC for health care, and a BHC medical van 

visits CDM weekly. Law enforcement agencies also use CDM as a resource for street homeless 

individuals encountered on patrol or being discharged from jail. Participants can go beyond ES 

by accepting case management services and entering CDM's substance abuse and employment 

programs. In addition, CDM has developed two transitional housing programs and permanent 

supportive housing, and is on track to open the city' s first safe haven by the end of 2003. 

First Light is especially important for providing single homeless women with emergency shelter, 

transitional and permanent supportive housing, and mental health and substance abuse treatment. 

A.IO 
Appendix A: Birmingham 

Permanent Supportive Housing 

The Jefferson County Housing Authority through its Shelter Plus Care Program is the largest 

funder of permanent supportive housing with 200 individual slots. Various providers actually 

operate the housing, including BHC (50 beds), Aletheia House (28 beds) and AIDS Alabama (39 

beds). All the providers accept referrals from other social service agencies. 

Supportive Services 

The major providers of emergency shelter and transitional housing also provide case 

management to assess individuai needs, develop a case plan, link participants to other supportive 

services and assist them in qualifying for public benefits such as Social Security Disability 

Income (SSDI), food stamps, and Medicaid. Agencies doing this work include Aletheia House, 

AIDS Alabama, YWCA, Bread and Roses, Community Kitchens, Birmingham Health Care, 

JBS, Interfaith Hospitality House, PATH, CDM, Salvation Army, and First Light Women's 

Shelter. 

JBS provides psychiatric assessments by appointment on Thursdays during its homeless clinic. 

Aletheia House provides substance abuse assessment Monday through Friday by Master's level 

therapists. AIDS Alabama provides assessment upon intake at its central facility, followed by 

referrals as needed. Interfaith Hospitality House provides intake and assessment upon entry into 

its facility. The YWCA's Compliance Manager meets with persons interested in housing and 

other services and conducts an assessment of needs. At BHC, all clients see a case manager who 

conducts a needs assessment covering housing, substance abuse, mental health, and social 

support needs. Jefferson County Housing Authority determines eligibility for Shelter Plus Care 

housing based on homelessness, income level, and documented disability of substance abuse, 

serious mental illness, and or HIV/AIDS. Pathways provide skills assessments to homeless 

women to identify skill levels for job readiness programs. 

Job training and referral is a key component of services in Birmingham. Aletheia House and 

BHC work together on a Homeless Veterans Reintegration Project. Funded by the U. S. 

Department of Labor, it provides job training and support services to more than 75 homeless 

veterans each year. HUD funds two other job training programs, one at BHC and one at 

Community Kitchens. BHC runs an I8-week on-the-job training program for homeless persons 

who graduate from substance abuse treatment. Community Kitchens operates a food preparationtraining program for homeless individuals. Bread and Roses and PATH operate job training for 

homeless women. Providers interviewed during our visit to Birmingham said that people in their 

programs have no trouble getting jobs, including those going through substance abuse treatment 

and those completing formal job training programs. 

Birmingham's CoC has several providers of mental health services. JBS provides assessment and 

mental health care to Binningham's homeless population. Cooper Green Hospital or University 

of Alabama at Birmingham (UAB) Center for Psychiatric Medicine provide facilities for 

hospitalizing seriously mentally ill individuals. Eastside, Western, and UAB Community Mental 

Health Center (CMHCs) provide ongoing treatment of mental health disorders. 

A.l3 
Appendix A: Birmingham 

The three main substance abuse treatment providers for the chronic street homeless population, 

CDM, Altheia House and BHC, have developed job training, work experience, and post 

treatment housing components so that individuals completing treatment do not have to return to 

emergency shelters. Once participants are working a portion of their earnings are applied to the 

cost of housing. 

Affordable Housing 

Birmingham has few government programs to promote affordable downtown housing. In fact, 

Aletheia House, originally just a substance abuse treatment program, has grown to be the largest 

developer of affordable housing in the Birmingham area. The Housing Authority of Jefferson 

County did not build its first public housing until the 1960s, completed its last units in the 1980s, 

and currently owns only 369 public housing units. It also operates a Section 8 voucher program 

and services twelve Farmer's Home Units. 

The housing affordability data for Birmingham partly explain this low level of activity. 

Compared to most metropolitan areas, it is relatively easy to buy a house in or near downtown 

Birmingham. In the 2000 Census, neighborhoods near downtown had median house prices below 

$50,000. However, apartment renting is a different story. Downtown apartment occupancy rates 

are over 95 percent, rents for a one-bedroom/one bath apartment start at $650 (Urban Land 

Institute, 2002), and about 35 percent of renters are unable to afford fair-market rent (Campbell, 

2001). There appear to be better opportunities to buy than to rent, and three formerly homeless 

people in our focus group had bought or were in the process of buying a home. 

As its economy grew during the 1990s, Jefferson County's population shifted to the suburbs, 

leaving downtown Binningham with fewer people and fewer housing units. Between 1990 and 

2000, Birmingham lost 6 percent of its households and 10 percent of its population. Annual 

house tear-downs outnumbered new house constructions 500 to 200. The availability of 

attractive new homes in suburban cities and the shift of population out of downtown is holding 

down the costs of the dwindling supply of old downtown houses. Although their prices are 

rising, they are far below national medians. 

Documenting Reductions in Chronic Street Homelessness 

Street Counts 

Birmingham has conducted street counts of its homeless population in 1995,2001, and 2003. 

Included in the data are breakdowns of street homeless individuals, some of whom may have 

been in families. The latest survey also asked detailed questions about the characteristics of the 

general homeless population. Table A.2 below includes data provided by Mark LaGory of the 

University of Alabama at Birmingham combined with data from the latest survey's executive 

report. The remaining data are from the executive report. 

A.14 
- - - - - - - - --

--

Appendix A: Birmingham 

T bl A 3 L , IA, t t I Emf St t H 

1 01 ~ ! I " " -

., '. , . I; - .1" 

" - .,-, .. _ • :...J.... • [ ~_ 'I" i I ,_ 

~irmingham City Agencies 

bepartment of Community Development: CDBG, HOPWA, ESG, X X and HOME, general revenue 

Police Department: general revenue X 

Franklin County Agencies 

efferson Co. Housing Authority: SHELTER PLUS CARE, Section X X X 8, general revenue 

\JBs MHIMR Authority: general revenue X X X 

/Community Development Department: CDBG X X 

tvA Medical Center (Federal) X 

Federal Agencies 

"Cederal Home Loan Bank X 

Health Care for the Homeless X 

A.17 
Appendix A: Birmingham 

Birmingham Site Visit Participants 

_: -::....:..~ ~ I ~,' \ ~ I - [ 

- -

- Rachel Cabanis First Light 

Angie Craft Jefferson Blount St. Clair 

_Charlotte-Ann Duckett The Old Firehouse Shelter 

Jonathan Dunning Birmingham Health Car.e 


Brenda Durham Jefferson County Housing Authority 


Rene Elliott Department of Veterans Affairs 


Steve Freeman The Old Firehouse Shelter 


Beverly Gosnell HUD Regional Office 


Brandy Herschbach Birmingham Health Care, Inc_ 


Chris Retan Aletheia House 


Jo Morris Sherer Church of the Reconciler 


John Stamps The Salvation Army 


Renae Thigpen Metropolitan Birmingham Services for the Homeless 


Sharon Waltz Birmingham Health Care 


Kim Williams The Old Firehouse Shelter 


A.18 
Appendix A: Birmingham 

Birmingham Acronyms 

BHC 

CAP 

CDM 

CMS 

ES 

JBSMHIMR 

HOME 

MBSH 

NOFA 

STOP 

UAB 

Birmingham Health Care 

City Action Partnership 

Cooperative Downtown Ministries 

Case Management System 

Emergency Shelter 

Jefferson-Blount-St. Clair Mental HealthlMental Retardation 

Federal block grant to create affordable housing 

Metropolitan Binningham Services for the Homeless 

Notice of Funds Availability 

Street Outreach Program 

University of Alabama at Birmingham 

A.19 
Appendix A: Birmingham 

A.20 
APPENDIX B: BOSTON 

Boston-Brief Description 

Boston is the largest city in Massachusetts and the 20tb largest city in the nation with a 

population of 589,141 in 2000, a 2.6 percent increase from the 1990 census.4 With its 

concentration of higher education, health care, financial services, professional and business 

services, and tourism.;hospitality, Boston has succeeded in transitioning from-a manufacturing 

to a knowledge-based economy. By 2000, Boston was enjoying one of the strongest economies 

in the nation-employment was at an all-time high with more than 113,000 jobs added 

between 1992 and 2000 and unemployment at a near record low of 2.9 percent. As in other 

parts of the country, however, the next two years saw many changes. A national recession and 

depressed stock market, coupled with the terrorist attacks of September 11 th, led to job losses 

and drastic reductions in state revenues and budgets (revenues declined by 26 percent in the 

spring quarter of 2002 alone). These in tum are threatening many social services and public 

health programs, especially those serving low-income and other vulnerable populations (The 

Boston Foundation, 2002). 

Against this backdrop, Boston city residents find themselves in the fourth most expensive 

housing market in the country (behind the borough of Manhattan in New York, San Francisco, 

and Chicago) and a crisis in affordable housing that is worsening every year. In 1994, a 

statewide referendum ended rent control in Boston and two surrounding communities 

(Brookline and Cambridge). This led to the loss of rent increase and eviction protections for 

60,000 units of affordable housing, and in the following two years another 8,000 to 20,000 

units were de-controlled in a phased process that further squeezed housing markets and 

unleashed escalating rents. By mid-2000, the rent for an average two-bedroom apartment in 

Boston was $1,448, a 59 percent increase from 1995 (City of Boston, 2002). In 1999, under the 

leadership of the Mayor Thomas M. Menino and the Housing Strategy Advisory Group 

(HSAG), Boston was able to save more than 1,000 affordable housing units from being 

converted to market rate housing and the city was able to develop more than 2,000 additional 

housing units. 

Recognizing the hardship caused by the lack of affordable housing, in 2000 the mayor 

launched an affordable housing plan, Leading the Way, as a blueprint for affordable housing 

production and preservation. Its overall goal, as outlined in a report on Boston's housing 

strategy, was to produce 7,500 new affordable housing units and preserve 10,000 existing 

affordable housing units by the end of2003; this goal was reached by mid-year (City of 

Boston, 2002). Of the new housing units, 2,100 units are earmarked for low-income residents 

(under 50 percent of area median income (AM1)) and 1 ,000 of these have been set aside for 

homeless people. 

Boston has struggled with increases in its homeless population through periods of both 

economic growth and decline. Between 1992 and 2002, the total number of people homeless in 

4 1990-2000 population statistics for Boston, quickfacts.census.gov/states/OOOOO.html . 

B. 1 
Appendix B: Boston 

Boston grew by 41 percent, reflecting rents that were increasingly out of reach for the lowest 

income families and individuals in-the city, and resulting in the expansion of service capacity, 

especially for transitional housing. Based on the city's annual street and shelter count, there 

were 2,606 single men and women homeless on the streets and in adult emergency shelters on 

December 9, 2002. Tllis was a slight decrease from the 2,700 people enumerated the year 

before (Emergency Shelter Commission, 2003). Tllis decrease may reflect the loss of more 

than 300 emergency overflow shelter beds in the city, and the added difficulty in counting or 

tracking those left unsheltered by tills loss. 

Boston has an extensive and committed community of service providers and advocates 

working with homeless people. Through a collaborative network of programs and services, the 

city moves several thousand individuals out of homeless ness each year through services such 

as street outreach and drop-in centers, emergency shelter, substance abuse and mental health 

treatment, medical services, educational programs, career development and employment 

services, transportation, and transitional and permanent housing programs. Service components 

specifically focused on ending chronic street homelessness are described in more detail in the 

section entitled "Selected System Components," along with activities and investments related 

to preventing homelessness and increasing the availability of affordable housing. 

On our visit to Boston on April 8-9, 2003, we toured several emergency shelters and housing 

programs in addition to interviewing over 70 individuals representing government and city 

agencies, nonprofit services agencies, street outreach teams, drop-in centers, shelter and 

housing providers; agencies serving homeless people through casework, mental health and 

substance abuse treatment, and health care; community development organizations, data 

managers and analysts, and other advocacy organizations. We also held a focus group 

discussion with individuals who had experienced chronic street homelessness and we rode 

along in two nighttime homeless street outreach vans. A full listing of persons interviewed, 

other than focus group participants, has been included at the end of tills appendix. 

Tllis chapter describes Boston's approach to ending chronic street homelessness. In addition, it 

describes in more detail the history and context of how its current system evolved, selected 

system components, funding mechanisms, community relations, documentation of Boston's 

success to date, and issues, gaps, and barriers that were identified by respondents during the 

site visit. The information contained in tllis chapter is derived from site visits, telephone 

interviews, written reports, agency websites, and Boston's 2002 Continuum of Care Homeless 

Assistance (CoC) application prepared by the city in collaboration with the Homeless Planning 

Committee (HPC). 

Practices of Potential Interest to Other Jurisdictions 

Boston offers several practices for reducing chronic street homelessness that may be of interest 

to other jurisdictions: 

• 	 Commitment of Local and State Dollars. Boston provides an excellent example of 

how state and city governments can take the lead in initiating and expanding programs 

to end chronic street homelessness. The state is the primary source of funding for 

B.2 
Appendix B: Boston 

emergency homeless assistance and oversees one-third of all transitional housing units 

in the city. Under the direction of Mayor Menino, the city staff participates in and 

provides technical support for groups planning services for the homeless. The mayor 

has also expanded theCoC by committing city revenues and leading efforts to find 

outside funding. (Contact person: Eliza Greenberg, Director, Emergency Shelter 

Commission, Eliza. Greenberg@cityofboston.gov, 617.635.4507.) 

• 	 Boston's Health Care for the Homeless Program (BHCHP). Boston has a singledecentralized system that is self-determined by homeless individuals and relies on the 

efforts of the street outreach teams to assist homeless individuals in getting off the 

streets. Through the coordinated efforts of the street outreach team and BHCHP, 

Boston offers a compassionate treatment modality that provides outreach, assessment, 

and health care services to homeless individuals in shelters and on the street seven days 

a week. In addition, BHCHP provides outreach vans and street outreach teams that 

assist homeless individuals by providing food, emergency care, medical assistance, 

referrals, and transportation to shelters, service providers, and hospitals. In 2001, 40 

percent of BHCHP clients were chronically homeless. (Contact person: Dr. Jim 

O'Connell, Director, joconnell@bhchp.org, 617.414.7779.) 

• 	 Area A-I. Boston relies on its partnership with the Area A-I Task Force to handle 

community issues regarding the homeless population in the downtown area. The Area 

A-I Task Force is able to bring to the table a strong collaborative which consists of 

providers, community members, health care professionals, support services, police 

department, formerly homeless and homeless individuals. Through the Area A-I Task 

Force, a dialogue of understanding between police department, service providers, the 

business community, and various health departments has been established and led to 

better coordination of services for individual street homeless people in the city's 

downtown community. (Contact person: Sergeant Tom Lema, Community Service 

Supervisor, 617.343.4238.) 

• 	 HomeStart. HomeStart is a Boston-based nonprofit housing agency that provides 

housing search, stabilization, and outreach services to homeless individuals. The 

agency works in partnership with shelter caseworkers t9 assist homeless individuals 

residing in shelters with locating housing. HomeStart also serves as a clearinghouse for 

the 10 percent of the Department of Neighborhood Development (DND) housing units 

that are set aside for homeless people. As such, it monitors leasing activity and provides 

information and outreach to potential applicants and referral sources for the set-aside 

units. HomeStart is able to provide some stabilization services to formerly homeless 

households for up to one year after placement. (Contact person: Linda Wood-Boyle, 

Director, woodboyle@homestart.org, 617.542.0338.) 

• 	 Management Information System. Boston has contracted with the Center for Social 

Policy at the McCormack Institute, University of Massachusetts to implement 

Connection, Service, and Partnership through Technology (CSP Tech), which 

maintains the HM1S data system. The system is used by over 40 providers and enables 

Boston to collect and track unduplicated information on over 4,750 homeless 

B.3 
Appendix B: Boston 

individuals and 350 homeless families in Boston. (Contact person: Nancy Sullivan, 

Director, nancyk.sullivan@umb.edu, 617.287.3393.) 

Primary Contact Person 

Eliza Greenberg, Director 

Emergency Shelter Commission 

One City Hall Plaza, Room 713 

Boston, MA 02201 

Telephone: 617.635.4507 

E-mail: Eliza.Greenberg@cityofboston.gov 

History and Context-How the Current System Evolved 

For nearly 20 years, Boston has made considerable efforts to combat homelessness through the 

coordinated efforts of government agencies, advocates, service providers, business leaders, 

nonprofit and public agencies, and consumers. Beginning in the early 1980s, Boston's homeless 

population increased dramatically as the city's economy began to deteriorate, its affordable 

housing decreased, and its mentally ill residents were being deinstitutionalized. To address the 

increasing demand for shelter, in 1983 Boston City Hospital opened its doors to provide 100 

temporary emergency overnight shelters beds for homeless individuals. Three months later, the 

city realized that the 100-bed facility was not sufficient to shelter the growing number of 

homeless individuals and began to develop and expand emergency shelters throughout the city of 

Boston. 

Massachusetts' governors and Boston mayors have led the development of programs to address 

home1essness. In 1983 the state became the primary source of funding for emergency homeless 

assistance, and that same year the city's mayor appointed three advocates to serve as the 

Emergency Shelter Commission (ESC). ESC was developed to assist homeless individuals with 

shelter needs and services through a referral process to community agencies. ESC also organizes 

the annual street count activities and provides information to the public on issues and data related 

to the homeless population. In 1994, the mayor created the HPC to assist the city with the 

development of supportive housing and services as well as the development of housing policies. 

HPC is composed of21 members (nominated by the community) who coordinate and plan 

activities and services for homeless individuals. 

In 1997, DND was established to oversee state and Federal funds for providing rental assistance 

for homeless individuals. Since the late 1990s, Boston has also developed a variety of preventive 

programs that aid individuals at risk of homelessness and move large numbers of individuals out 

of homeless ness and into housing. The collaborative efforts of ESC, DND, and HPC have 

secured over $40 million in new resources for homeless services and housing; these funds have 

supported the creation of a coordinated system of care that offers many different options for 

homeless individuals as well as individuals at risk of homeless ness. 

8.4 
Appendix B: Boston 

Approach to Chronic Street Homelessness 

Boston estimates that approximately 40 percent of people in its shelter system at any given time 

meet the following definition of chronic homelessness: an individual with a disability (such as 

mental illness, substance abuse, HIV/AIDS, physical impainnent, and dual diagnosis) that 

substantially impedes independent living who has been living on the streets (or other places not 

meant for human habitation) or emergency shelter for over two years.

5 They also report that of 

the 178 homeless people receiving outreach and/or healthcare services through Boston's Health 

Care for the Homeless Program (BHCHP) in 2001, 71 percent bad been homeless for more than 

three years. Using point-in-time data from the city's December 2002 homeless census, Boston 

estimates that they have about 1,042 chronically homeless people in their community. Of these, 

212 were enumerated on the street and the remaining 830 in shelters (it should be noted, 

however, that the 2002 census was conducted on a bitterly cold night and, therefore, the number 

of street dwellers was much lower than usual). Confirming the fmdings of many other studies, 

Boston has found that chronically homeless people in their community are predominantly male, 

single, and between the ages of25 and 74. 

Boston's main approach to ending chronic street homelessness to is to maintain and strengthen 

its current homeless service system (at a time when both Federal and state funding streams have 

been reduced), strengthen its outreach and assessment efforts, and increase the number of 

transitional and permanent supportive housing units (including various types of low-demand 

housing). The community has decided to prioritize projects that serve chronically homeless 

people, and the city of Boston has established a goal of creating 100 units of permanent 

supportive housing per year to address their housing needs. Efforts to improve coordination and 

collaboration among service providers to better meet the needs of underserved populations 

(including chronically homeless people) and prevent homelessness through improved discharge 

planning and cross-agency coordination are ongoing. 

Boston's approach for ending chronic homelessness has built on the experience and expertise of 

outreach and emergency shelter providers whose service to this population covers both the 

explosion of homelessness of the 1980s and the evolution of a continuum of services of the 

1990s. Assessments conducted by the city's Emergency Shelter Commission in 1995-96 

identified gaps in the outreach, service, and housing needs of unsheltered homeless people. The 

citywide provider and community response has resulted in a significant increase in service 

infrastructure, targeted resources, and long-term transitional and permanent housing outcomes 

for this vulnerable population. 

Coordination of these efforts is largely the result of strategic planning efforts of the City of 

Boston's Homeless Planning Committee, a diverse body of 19 members who represent city 

housing and homelessness planners, service providers, advocacy coalitions, and consumers who 

are leaders in Boston's efforts to fight homelessness. In 1998, the HPC convened the Strategic 

Homeless Planning Group (SHPG) to develop a five-year strategic plan to address rising 

5 Note this definition of chronic homelessness is broader than the one used for this study, which does not include 

people with long-term stays in emergency shelter. These estimates are based on data collected from Boston 's 

service providers and CSPTech (Boston's homeless management information system). See Boston's Continuum of 

Care Homeless Assistance (CoC) Application, Boston, MA, 2002, p. 6-E. 

B.5 
Appendix B: Boston 

homelessness in the city. The mission of SHPG was to ensure that Boston's overall homeless 

planning and policy decisions included meaningful input from a wide range of key entities, and 

to identify innovative strategies to address homeJessness in Boston (Strategic Homeless Planning 

Group, 2000). The organization chart below shows the many agencies and ot.her bodies involved 

in planning and developing the city's homeless service system. The HPC oversaw and 

coordinated the activities of the SHPG, while the ESC and the DND provided technical 

assistance and policy direction for SHPG on behalf of the HPc. The SHPG was comprised of six 

committees composed of key stakeholders that focused on specific planning topics, namely 

homeless prevention; outreach, emergency shelter, and transitional programs; permanent housing 

(including search and stabilization services and permanent supportive housing); income, 

employment, and related supports; integrated hea1th care; and consumer involvement. 

Chart B.1 

Strategic Homeless Planning Group 

Homeless 


Planning 


Committee 


Emergency Department of 

Shelter Neighborhood 

Commission Development 

-State Agencies 

-Local Government -Businesses STRATEGIC 

Agencies -Banks HOMELESS 

-Non-Profit -Neighborhood Groups PLANNING GROUP -Educational/Health 

-Follnrliltions 

Organizations 

Institutions 

Homeless Outreach, Emergency Housing Search, Income, Health Care Consumer 

Prevention Shelter, and Permanent Housing, Employment. and Committee Involvement 

Committee Transitional Programs and Stabilization Related Supports Committee 

Committee Services Committee Committee 

B.6 
Appendix B: Boston 

SHPG has developed a five-year strategic plan to guide the community in ending homelessness 

based on information obtained from the six committees of SHPG. The major recommendations 

(goals) of the plan are to: 

• 	 Expand the supply of and access to permanent affordable housing; 

• 	 Expand employment opportunities and economic services to assist homeless people in 

becoming self-sufficient; 

• 	 Prevent homelessness through improved discharge planning and ongoing coordination 

among state and local criminal justice and social service agencies; 

• 	 Maintain and strengthen the existing infrastructure and current capacity of Boston's 

homeless system; 

• 	 Improve coordination and collaboration among homeless providers to meet the needs of 

under-served populations; and 

• 	 Advocate with Federal, state, and local agencies to increase public awareness and 

access to mainstream resources (Strategic Homeless Planning Group, 2000). 

Boston uses the assistance ofConnection, Service, and Partnership through Technology 

(CSPTech) to examine the demographics and characteristics of individuals the system serves, 

as well as how homeless services are coordinated. CSPTech also maintains the Homeless 

Management Information System (HMIS), which tracks over 4,750 homeless individuals in the 

city of Boston. The Hl\1IS is used and updated by over 40 agencies throughout the city as well 

as city planners who allocate mainstream resources. CSPTech is housed at the Center for 

Social Policy in the McCormack Institute, University of Massachusetts Boston. 

The many agencies involved in reducing/ending chronic street homelessness in Boston are 

shown in Table B.1. 6 The rows of the table represent Boston agencies that offer one or more 

types of services for street homeless individuals, while the columns represent the types of 

programs and services they offer. An "X" in a cell indicates that the agency offers the 

particular service listed at the top of the column. An "F" indicates that a public agency funds a 

program or service, and an "E" indicates that the agency offers expert advice, technical 

assistance, or training. 

Mainstream Agency Involvement 

Boston provides an excellent example of how state and city government can take the lead in 

initiating and expanding programs to end chronic street home1essness. As early as 1983, 

Governor Michael Dukakis expanded overnight emergency shelters and day programs for 

Table B.1 represents specific agencies involved in Boston's CoC efforts to provide services to chronic street 

homeless individuals; it does not include agencies that provide services for homeless families with children and 

homeless youth. 

B.7 

6 
Appendix B: Boston 

homeless individuals. Under his leadership, significant planning to end homelessness emerged 

and th.e state became the primary source of funding for emergency homeless assistance. Today, 

the Massachusetts DepartmenLof Mental Health (DMH) is also a major provider of transitional 

housing in Boston. Under the direction of Mayor Menino, city officials participate in and 

provide technical support for the Homeless Planning Committee and the more broadly focused 

Strategic Homeless Planning Group. Mayor Menino has also expanded the CoC by committing 

significant amounts of city revenues annually and leading efforts to [rnd outside funding. 

Other state level mainstream agency involvements in Boston programs to end homelessness 

include the following: Executive Office of Health and Human Services provides special 

allocation Section 8 vouchers for homeless individuals with disabilities. The Department of 

Transitional Assistance (DT A) provides outreach, on-site health services, emergency and 

transitional shelter, day programs, supportive services and case management. DMH provides 

supportive services for chronically homeless mentally ill people moving to permanent housing, 

transitional shelters, on-site mental health services in emergency shelters, day rehabilitation and 

employment programs, outreach assessment, and crisis intervention. The Department of Public 

Health (DPH) assists in street outreach, detox, emergency shelter, case management, support 

services, recovery homes and residential treatment centers, and dental care-as well as special 

rental assistance, supportive services and residences for homeless persons with mY/AIDs. 

Department of Veterans Services provides shelter and transitional housing for homeless veterans. 

Executive Office of Elder Affair provides emergency housing and case management for 

homeless elderly. In addition, Department of Education provides on-site literacy and adult basic 

education; Division of Medical Assistance does Medicaid enrollment outreach in shelters; the 

Department of Housing and Fair Practice provides intensive case management and primary care 

by nurse practitioners; and the Massachusetts Housing Partnership operates permanent housing 

projects. Mainstream state programs provide substantial funding support in Boston. The largest 

programs are DMH and DTA at over $20 million each and DPH at over $14 million. Other 

substantial state programs are Multifamily Housing Program ($4.6 million), Department of 

Housing and Community Development ($3.5 million), and Department of Veterans Services 

($2.7 million). 

Boston city departments or programs that provide funding or staffing to end homelessness 

include: the Emergency Shelter Commission, which coordinates policy, provides funding for gap 

services, targets resources toward emerging needs, and advocates for constituent services; the 

DND, Boston Housing Authority (BRA), and Boston Redevelopment Authority (BRA), the 

partner agencies for Leading the Way, develop permanent housing; Neighborhood Development 

Funds provide move-in and short-term rental funds and develop permanent housing; the Public 

Health Commission's Homeless Services provide emergency shelter, stabilization services for 

substance abusers, employment and training through transitional housing programs, and develop 

permanent housing; Lead Safe develops permanent housing; BRA develops permanent housing; 

and general city funds support emergency shelters and related services. General city funds, 

which totaled $5.6 million in programs for homeless individuals, are the largest city resource. 

Leading the Way provided $0.9 million and the Public Health Commission $0.2 million. 

B.8 
Appendix B: Boston 

Table B.1: Ci!y of Bo_ston: Agencies Involved in Reducing/Ending Chronic Street Homelessness 

Nonprofit Programs' Servlcesl Agencies Serving 

Currently or Formerly Chronic Street Homeless People 

(listed alphabetically) 

Pme Street Inn 


Friends off Ihe Shatiuck Shelter 


St. Francis House 


Boston Health Care for the Homeless 


Home Start 


DMH Homeless OutreaCh Team 


Tri-Cily Mentat Health 


Boston Public Health Commission Homeless Services I 

New England Shelter for Homeless Veterans 

Victory Prog rams 

New England Medical Center 

Community Work Services 

Massachusetts Coalition for the Homeless Massachusetts Housing and Shelter Alliance 

Ecclesla Ministries/Neighborhood Acti on 

Homeless Emergency Action Task Force 

Government Programsl Servlcesl Agencies Serving 

Currently or Formerly Chronic Street Homeless People 

Emergency Sheiler Commission (ESC) 

Department of Neighborhood Development (DND) 

Area A-1 Task Force 

Department of Transitional Assistance (OTA) 

Department of Mental Health Department of PubliC Health (D PH) 

Boston's Emergency Medical Services (EMS) 

Massachusetts Department of Housing and 


Community Development (MDHCD) 


Boston's Public Health Commission 


Boston Housing Authority 


Metropolitan Boston Housing Partnership (MBHP) 


UMass Boston Center for Social 

.$" 

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x x I X 

X X X X 

X I X X 

x X 

X X X 

X X X X 

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X X I 

X 

X X 

X 

F I F 

F F I F I X. F I 

X. F I X.F lx,FI X,FI 

X 

X F 


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Homeless-Related Programs and Services 

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X I X X 

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X 

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ElF E E E E I E 

F I F E.F E E E 

E E 

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X X 

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X 

F X 

X.E X.EI X 

x = Provider E '" Expert TA Provider F'" Funder 

8.9 
Appendix B: Boston 

In Boston, private resources being tapped for programs to end homelessness range from 

foundations to city-imposed developer fees . Cash donations from individuals to programs were 

also substantial, totaling $12.5 million. The private mainstream resources include: tax-credit 

equity funding from private investors; city fees paid by developers to fund permanent housing; 

private bank loans for permanent housing; Developer's Equity for permanent housing; United 

Way emergency shelter, transitional housing, and support services; cash, and in-kind donations 

from businesses, religious, and civic organizations totaling over $3.6 million; and over 50 

foundations contributing over$9 million. The United Way is the largest single private 

mainstream resource providing over $3 million. Other large private funders are the Boston 

Foundation Starr Fund ($1.3 million), Developer's Equity ($1.1 million), Putnam Sr. Executive 

Fund ($1.1 million), and Fireman Foundation ($1.5 million). 

Exhibit B.l and Table B.l clearly illustrate that Boston has succeeded in getting most of its 

agencies "at the table." Planning and decision-making around homeless services appear to be 

broad, democratic, and very inclusive. 

Selected System Components 

Boston has a comprehensive well-coordinated continuum of care that serves all homeless people 

including those who are chronically homeless. This system includes prevention efforts, outreach 

and drop-in, some save havens and other low-demand residences, emergency shelters, 

transitional and permanent supportive housing, supportive services, and affordable housing. Each 

of these components is described in tum. 

Prevention 

Boston has a variety of homelessness prevention programs. In general these programs help 

people at risk of homelessness obtain the necessary resources to prevent them from becoming 

homeless. These resources include housing counseling to support housing stability, 

rent/mortgage/utility assistance, preservation of existing affordable housing to prevent current 

occupants from being displaced, housing stabilization for previously homeless individuals, and 

diversion plans targeting special populations at risk of homelessness. 

Of particular benefit to chronically street homeless individuals are programs offering substance 

abuse recovery beds available to people leaving the criminal justice system and precluding their 

entry into the emergency shelter system. Five different agencies throughout the city offer 35 such 

beds in all. The Massachusetts Department of Mental Health is a major contributor to primary 

and secondary prevention of homelessness through its transitional housing programs discussed 

below in the transitional programs section of this chapter. Other prevention activities are 

available to Boston veterans. With over $260,000 in state funding, the Veterans Benefit 

Clearinghouse runs an outreach center that provides veterans with food, housing, and other 

services that help keep them stably housed. 

In addition to these, Boston is also working through the collaborative efforts of HomeS tart and 

the Metropolitan Boston Housing Partnership. The city provides annual rental stipends, money 

management, and supportive services to at least 100 formerly homeless individuals. HomeStart 

B.I0 
Appendix B: Boston 

is another agency that provides general prevention assistance and counseling services to 

formerly homeless individuals through Federal, state, and city flJnds and with the support of 

several private foundations. 

Boston's CoC is also working to develop additional programs that will expand current 

preventive efforts. The City of Boston's 2002 CoC Homeless Assistance Application included 

several preventive strategies. The Clean Slate Project addresses issues of homeless ness among 

ex-offenders and methods needed to change discharge policies to prevent homelessness; the 

Tenancy Preservation Project is a linkage of supportive services and housing for individuals 

who are chronically homeless; and the Boston Diversion Project is a diversion plan for nonviolent mentally ill offenders to move into treatment facilities rather than incarceration. 

Outreach and Drop-In 

Boston's outreach efforts build on the city's longstanding commitment to provide shelter, 

services, economic, and housing opportunity to every person in need. A gaps assessment 

conducted by the Emergency Shelter Commission led to the addition of the Pine Street Inn's 

Project NeighBOR in the city's first McKinney CoC application to HUD. At the same time, the 

DPH began funding the Friends of the Shattuck Shelter street outreach programs. Beginning in 

1997, the BHCHP also began to field a nurse practitioner working on the streets, and Tri-City 

Mental Health intensified mental health outreach to unsheltered persons on the streets of Boston. 

Collectively, these programs enhanced existing overnight mobile outreach efforts and the 

Department of Mental Health's Homeless Outreach Team (HOT) that had served the chronic 

street population since 1986. Outreach efforts in Boston were re-examined and strengthened after 

the street deaths of more than 13 homeless individuals in 1998. Under the leadership of Mayor 

Menino additional resources from the city's budget were allocated to provide funding for a 

second night outreach van, and through the city's Emergency Shelter Commission, provided 

funding for additional street outreach to chronically homeless people in the evenings. The three 

lead agencies conducting street outreach in Boston, Friends of the Shattuck Shelter, Pine Street 

Inn, and Tri-City Mental Health, see a majority of chronically homeless individuals. They 

provide extensive outreach activities intended to assist homeless individuals in getting off the 

streets, while linking them to supportive services, fixed-site case management and, ultimately, 

housing. These agencies provide day and night street outreach activities to specific geographical 

areas in Boston, offering a range of intensive case management services for homeless 

individuals. Outreach services include food, clothing, blankets, medical care, psychiatric 

services, and referrals for treatment and housing services. Outreach teams also provide 

transportation or vouchers for city transport to homeless individuals going to shelters, detox, or 

drop-in centers. 

Street outreach teams work collaboratively with other agencies such as DMH's HOT Team, 

BHCHP, and Boston Emergency Services Team (BEST). Together these agencies provide onthe-street health care services to homeless individuals. HOT employs clinical workers to assist 

the street outreach teams in identifying and assessing the health care needs of homeless 

individuals. Once an individual moves into the shelter or other types of housing, HOT continues 

to provide a system of care to meet individuals' needs. 

B.11 
Appendix B: Boston 

BHCHP is another health care organization that works in collaboration with the street outreach 

teams to provide emergency care, limited medical assistance, referral, and transportation to city 

hospitals. BHCHP maintains the medical records of homeless individuals through hand-held 

computers that link to extensive medical records_ throughout the hospi tal and shelter-based clinics 

and street teams of the BHCHP health care network. BHCHP will continue to provide unlimited 

services to the individuals until they move into pennanent housing with supportive care. They have 

also started t.lllnking about providing primary health care (such as monitoring blood pressure) to 

people who are homeless on the street. The director of Boston's BHCHP noted that health issues 

are "a great front door" into housing from both the client and housing provider'S perspective, that 

the community needs options for different types of housing, and that everyone has to share in 

creating the avenues into housing. As an example, he noted than an individual street homeless 

person may break a leg, come into a BHCHP facility for treatment, get sober and begin to think 

clearly, and then conclude "I don't want to go back out there," meaning to the streets. 

Unfortunately, it can take a year or longer before getting someone into housing. 

BEST also works with the street outreach team in a capacity that provides crisis intervention to 

chronically homeless mentally ill individuals who are suicidal, violent, or in need of urgent care. 

Outreach teams also work with the Boston Police Department (BPD), the Boston EMS, local 

businesses, and community residents to identify homeless individuals in need of services. They 

monitor an outreach phone line that receives calls during the evening hours pertaining to the 

whereabouts of homeless individuals in need of shelter or care. 

Another group that has been instrumental in Boston's effort to address chronic street 

homelessness in the downtown area is the Area A-I Police District Homeless Task Force. 

Developed in 1994 under the leadership of Boston Police Captain Ronald Conway, the 

Downtown Crossing Association, the Pine Street Inn, and the City of Boston's Emergency 

Shelter Commission, the Area A-I Task Force is comprised of over 30 representatives from 

various community agencies and programs that collectively identify and engage street homeless 

people and work repeatedly to get them off the streets and connected to needed services. 

Members of the Area A-I Task Force include the Boston ESC, the Boston Parks and Recreation 

Department, the Boston District A-I Police Department, the Pine Street Inn, Shattuck and 

BHCHP street outreach teams, the D.MH, City Council, local businesses, representatives from 

area hospitals, Emerson College and other educational institutions, nonprofit and public 

agencies, and fonnerly homeless and homeless individuals. 

The Area A-I Task Force meets on a monthly basis to address homeless issues and problem 

solve efforts to reduce homelessness. Through the Area A-I Task Force, members quantify and 

prioritize the gaps to be filled in the collaborative effort. In addition, attendees of the Area A-I 

Task Force meetings are able to vent, share infonnation, make connections among the provider 

community, and develop dialogues of understanding on issues of homeless ness. 

The Downtown Crossing Association is a nonprofit agency that, in addition to being one of the 

Area A-I Task Force leading members, works on economic and cultural development in the 

downtown retail district. The Association involves retail, civic, and higher educational 

institutions to bring innovative ideas and partnership with providers and downtown businesses to 

enhance outreach efforts, interventions, and assistance for homeless individuals in the downtown 

area. The Association facilitates communication between downtown businesses, the police, and 

B.12 
Appendix B: Boston 

service providers when they have an issue or concern regarding homeless individuals residing in 

downtown neighborhoods. TheAssociation also provides office space and support for Project 

NeighBOR. 

Emergency Shelters 

For more than three years emergency shelters in Boston have had to operate at full capacity plus 

periodic overflow situations. The 2002 annual homeless census found 2,394 individuals residing in 

the city's 14 emergency shelters for single adults (Emergency Shelter Commission, 2002). This is 

a slight decrease from the 2001 annual street count, which documented 2,423 individuals residing 

in the shelters. 

Boston's emergency shelters are designed to offer a temporary place for homeless individuals to 

reside until they can receive supportive services to move into permanent housing. Currently 

Boston has 1,729 emergency shelter beds available for single homeless adults (with an additional 

300 temporary emergency shelter beds available during the winter months). Two of the city's 

emergency shelters (with 93 beds in total) are actually innovative programs run by BHCHP that 

provide medical respite care. These programs offer short-tenn residential care for homeless 

adults who do not require hospitalization, but are too ill to sustain the stresses of staying in an 

emergency shelter or living on the streets. In some of the other adult shelters throughout the city, 

more than 80 emergency beds have been converted into post-detox pre-recovery beds because of 

the shortage in post-detox recovery beds in the city. This conversion has been done in an effort to 

prevent people from going (back) out to the streets. 

Homeless individuals can come into emergency shelter through self-referrals, walk-ins, outreach 

workers, BPD, or EMS. As part of Boston's collaborative effort, any homeless individual turned 

away from an emergency shelter because of sleeping capacity will be transported to another 

shelter that has an available bed. 

Low-Demand Residences 

Although Boston has a well-developed continuum of care, the city does not currently have many 

units of "low-demand" housing for chronically homeless people. There is one save haven in the 

city, run by Tri-City Mental Health, with six beds devoted to mentally ill homeless women. TriCity Mental Health provides referral services, food, clothing, home furnishings, or other items 

needed to make the individual feel safe in his or her residence. Other "low-demand" housing 

options include some post-detox housing and Shelter Plus Care units. According to Boston's 

2002 CoC Homeless Assistance application, the few low-demand programs they do have may 

need to be closed down because of funding shortfalls. 

Transitional Programs 

The city of Boston has close to 1,408 transitional housing slots, provided by 38 agencies, that are 

designed to provide rehabilitative and social services for up to 24 months to assist homeless 

individuals to move into permanent affordable housing. Through Boston's transitional programs, 

B.13 
Appendix B: Boston 

homeless individuals are able to receive outreach, case management, health care, recovery and 

relapse prevention, job training, parenting classes, and social services benefits to assist them as 

they transition back into the community and into permanent housing. Many of the city's 

transitional housing programs are focused on special populations such as substance abusers (1,005 

beds in 2000), mentally ill people (325 beds), veterans (148 beds), those with dual-diagnoses 

(165), and HIV/AIDS patients (136). 

A major provider of transitional housing in Boston is the state DMH. It oversees about onethird of all transitional housing beds in the city's shelter system. DMH has targeted 50 percent 

of its transitional housing units for individuals who have experienced recent evictions, were 

inpatients, or were recently released from prison. Boston's winter 2002 count of homeless 

people documented 325 people in state Department of Mental Health programs. 

Boston's process for transitional housing is to assist homeless individuals and individuals at 

risk of homeless ness to obtain supportive services while maintaining residential stability within 

the community. Homeless individuals receive the linkages they need to move out of short-term 

residential settings and into independent living environments. 

Permanent Supportive Housing 

The City of Boston has developed 2,090 permanent supportive housing units of which 355 are 

Shelter Plus Care units that serve formerly homeless persons, and as part of Boston's CoC 

effort, the city has a three-year blueprint to develop more permanent housing for the homeless 

including 128 additional PSH units (91 for single homeless people) with $2.5 million in city 

funds. In Boston's 2002 CoC application to mID, the only new projects seeking funding were 

those creating permanent supportive housing units. In addition, the city's homeless set-aside 

policy requires that at least 10 percent of all city assisted rental housing units be reserved for 

homeless individuals and homeless families. The city has also requested that the Boston 

Housing Authority (BHA) develop a policy that would grant Priority I status to homeless 

individuals for Section 8 Vouchers, and that BHA continue to set aside 100 Section 8 subsidies 

for homeless individuals. 

The total number of Permanent Supportive Housing (PSH) units administered by the city 

includes 355 Shelter Plus Care units; 80 Housing Opportunities for Persons with AIDS 

(HOPWA) units; 800 Section 8 and public housing units; and 634 Moderate Rehabilitation 

Units. Individuals from the city shelters and transitional housing programs can access PSH 

services through HomeStart and ABCD. Both agencies provide housing placement services 

such as referrals for PSH, housing search, and assistance with housing application based· on 

individual needs. 

In addition to the individual agencies that provide PSH services, the Massachusetts funds Mass 

Access, an interactive web-based computerized registry that monitors and tracks vacant 

housing units across the state that are accessible to homeless individuals and families. 

B.14 
Appendix B: Boston 

Supportive Services 

Boston has a wide array of supportive services to help homeless people move through its 

continuum of care. These services include case management services for more than 6,705 

homeless individuals; life skills services for up to 5,013 homeless individuals; alcohol and drug 

abuse services for up to 1,625 homeless individuals; mental health services for 1,203 homeless 

individuals; HIV / AIDS related services for 2,010 homeless or previously homeless individuals; 

educational activities such as vocational rehabilitation, Graduate Equivalency Diploma and 

English as a Second Language courses for up to 250 homeless individuals; employment 

assistance services and training for up to 1,731 homeless individuals; and housing search and 

placement services for up to 4,051 homeless individuals. Transportation services are offered to 

assist homeless individuals in need of shelter, treatment, or services; and free health care 

services are offered for homeless individuals through BHCHP and MassHealth (the state 

Medicaid program). 

Boston like many cities across the country continues to struggle with targeted budget cuts, 

which have caused a dramatic decrease in the number of available detox and recovery beds for 

homeless individuals. The winter 2002 annual street count reported that 292 homeless 

individuals were residing in detox facilities, up from 277 in 2001 . With fewer detox and 

recovery beds as a result of the budget cuts, the already growing number of homeless people 

living on the streets and in shelters may increase further. 

The city of Boston has been able to provide the above services through funding from the city, 

state, and Federal resources as well as McKinney Act funding and grants from private 

foundations. Through the efforts of the CoC and various funding mechanisms, Boston has been 

able to offer a variety of services and support to meet the individualized needs of the homeless 

population. Information about these services is disseminated through the city's referral guide, 

community posters, word of mouth, or by calling an interactive voice system that provides up-todate information. 

As in many communities, there are many obstacles to providing dually and triply diagnosed 

homeless people (those with mental health, alcohol or drug use, and even physical health 

problems) with housing and other supportive services. Many of these obstacles stem from the 

multiplicity of the problems and the fact that the service systems for mental illness, substance 

abuse, and physical health often operate autonomously. 

Affordable Housing 

The city of Boston, being the fourth most expensive housing market in the nation, is acutely 

aware of the challenge of maintaining and developing affordable housing. The mayor and SHPG 

have developed a three-year strategic plan, Leading the Way, to expand affordable housing for 

low-income and homeless individuals and families. The city is contributing over $30 million and 

city-owned land to achieve the plan's goals of building 7,500 new affordable housing units and 

preserving 10,000 units of existing affordable housing. During FY 2002 the city of Boston 

allocated an additional $3 million from the city's budget to go towards affordable housing once 

B.15 
Appendix B: Boston 

the existing funds were exhausted. To date, 34 percent of the city's affordable housing units are 

targeted to low-income households earning less than 50 percent of AMI.7 In addition, the city's 

homeless set-aside policy requires that at least 10 percentof all city-assisted rental housing units 

be reseIVed for homeless individuals and homeless families with an income no greater than 30 

percent of AMI. Through DND, the homeless housing set-aside policy also requires that any 

unoccupied set-aside units remain vacant until occupied by a homeless household. The city has 

also requested that BRA develop a policy that would grant Priority 1 status to homeless 

individuals for Section 8 Vouchers, and that BRA continue to set aside 100 Section 8 subsidies 

for homeless individuals (not a large number relative to need). 

Documenting Reductions to Chronic Street Homelessness 

Beginning in 1986 the ESC has conducted annual street counts in Boston with the assistance of 

over 250 volunteers who cover designated geographical areas in the city to enumerate homeless 

individuals sleeping on the streets and in the city's shelters and other homeless facilities. 

According to the December 2002 annual street count, the total number of homeless individuals 

residing on the streets of Boston and in adult emergency shelters has increased over the last 

decade: 

The number of Boston's homeless has increased by 41 % in the past decade. There are 6,210 

homeless people in the City of Boston in 2002 compared to 4,411 in 1992. There are 1,367 

homeless children in Boston in 2002 compared to 800 in 1992, an increase of 71 %. There were 

1,572 homeless women in 2002 compared to 989 in 1992, an increase of 59%. There are 

3,271 homeless men in 2002 compared to 2,622 in 1992, an increase of 25%. Although the 

number of homeless men is rising at a slower rate than that of women and children, they continue 

to be the largest percentage of the population, 53%. The majority of these men have chronic 

disabilities such as mental illness and/or substance addiction (Menino, 2002, p.2). 

The increase in the number of homeless individuals can be traced directly to a number of 

conditions, including but not limited to: 

• 	 The dramatic rise in housing costs; 

• 	 The decrease of affordable housing for low-income persons; 

• 	 A reduction of substance abuse treatment beds; and 

• 	 A lack of commitment to aftercare planning and next step resources for individuals 

being released from jails and prisons, acute mental health facilities, hospitals, and social 

seIVlces. 

7 Note that SSI benefits in Boston (which in 2002, would be $659.39 per month, a figure that includes a statefunded supplement of$114.39) amount to only 15.2 percent of AMl. Housing priced at 50 percent of AMI is still 

out of reach for most SSI beneficiaries. See Ann O'Hara and Emily Cooper, Priced Out in 2002, Technical 

Assistance Collaborative, Boston, MA, May 2003, p. 23. 

B.l6 
Appendix B: Boston 

In an effort to track the demographic information on homeless individuals, the city of Boston has 

contracted with the Center for Social Policy at the McCormack Institute, University of 

Massachusetts to implement Connection, Service and Partnership through Technology which 

maintains the HMIS data system. Formerly known as the ANCHoR project, the HMIS data 

system is used by over 40 providers and enables Boston to collect and track unduplicated 

information on over 4,750 homeless individuals and 350 homeless families in Boston in order to 

provide unduplicated services and other resources needed to assist homeless individuals move 

towards self-sufficiency and pennanent housing. 

Last year, provider data revealed that at least 1,500 homeless people obtained pennanent housing 

throughout the city of Boston, including 550 chronically homeless individuals. The Pine Street 

Inn's Project NeighBOR, which serves chronically street homeless people, reports that of356 

clients who exited the program in the past two years, 38 percent (134) obtained permanent 

housing and another 22 percent (77) was referred into a transitional housing program. The 

majority of clients in 2001-2002 were successfully placed into housing and more than 60 percent 

of them (103 of 171) entered housing after more than four years ofhomelessness (another 19 

percent had been homeless between one and four years). The program achieved similar results 

more recently in 2002-03: 58 percent (108 of 185) of those housed had been homelessfrom 4-6 

years, and 26 percent (48 of 185) had been homeless for 1-4 years. Most of the individuals 

successfully placed are repeat users of health care, mental health care, substance abuse, and 

shelter services and the locus of care and services simply shifted from the streets to fixed-site 

programs that served as a staging area for their successful placement into transitional and 

permanent housing. 

Public Funding 

The Boston CoC makes very significant use of Federal, state, and local mainstream agencies. 

Some of the funding provides emergency shelter and services rather than directly moving 

homeless individuals into transitional and permanent housing. However, the mainstream 

funding of emergency needs can be used to free up resources for agencies with a focus on 

ending homelessness for individuals. Some of the programs assist families as well as 

individuals, but in the discussion below we omit programs that serve only families. 

The sums received from the Federal programs are very substantial. As Table B.2 shows, these 

funds support services, staffing, and housing (both capital investments and operations). Federal 

mainstream agency involvement in programs for chronic street homeless people in Boston 

including the following: HUD Community Development Block Grants ($0.5 million) support 

permanent housing development, move-in and short-tenn rental funds; HUD, Home Investment 

Partnerships Program ($3.5 million) funds pennanent housing development; HUD Section 8 

vouchers ($25 million not limited to homeless assistance) cover client rent; BUD Housing 

Opportunities for People with Aids ($1.0 million) funds housing search, case management and 

transitional programs; DHHS Mental Health Block Grants provide outreach, assessment, crisis 

intervention and support services; DHHS Substance Abuse Block Grants ($5.2 million) support 

transitional recovery homes, treatment clinics, detox and related services; a DHHS Welfare-toWork Block Grant provides on-the-job training of homeless individuals; DHHS Projects for 

Assistance in Transition from Homelessness fund outreach and supportive services for homeless 

B.l7 
- -

------------------------------------------------------------------------------

Appendix B: Boston 

people with mental illness; DHHS also funds various HIV services ($1 .6 million) and a 

combination of outreach and health care at local sites providing services for homeless individuals 

($1 .9 million); a Department of Labor Homeless Veterans Reintegration Project ($0.6 million) 

provides employment and training services, as well as, vouchers for homeless veterans to attend 

computer training programs; Emergency Food and Shelter Program provides shelter and meals; 

and the Federal Home Loan Bank ($0. 5 million) provides capital funds for permanent housing 

development.8 

Table B.2: Boston Investments in Ending Street Homelessness 

- - , - .. 

- , I 

- I I ' 1·_ 

= -

Department ofNeighborbood Development 


(SHP, ESG, SPC, HOPWA, SRO Mod Rehab, X X 


HOME,CDBG) 


Boston Housing Authority (Section 8-both X X

tenant and project based, admin. funds) 

Department of Mental Health (MHBG, PATH) X X X 


Department of Public Health (SABG) X X 


Department of Medical Assistance (Medicaid, 
 X Medicare) 

Department of Transitional Assistance X X 

Boston Public Health Coll1ITlission X X X 

Department ofYeterans Services X X 

Emergency Shelter Coll1ITlission X X X 

Department of Housing and Community X Development 


Nonprofit Providers (use myriad funding 
 X X X

streams including private $) 


Boston Police Department X 


lnspectional Services Department X 


Executive Office of Health and Human 
 X Services 


Boston Emergency Medical Services X 


g Figures cited from Boston's 2002 Continuum-of-Care Application. 

B.18 
Appendix B: Boston 

Community Relations and Advocacy 

There is a well-established and active homeless advocacy community in Boston and throughout the 

state of Massachusetts. Homeless service providers also enj-oy the strong support of local political 

leaders, including the Mayor of Boston who has guaranteed every homeless person an emergency 

shelter bed. However, despite high levels of advocacy and political support, the community 

continues to struggle with very severe NIMBYism. This is probably due to the tight housing 

market generally, and perhaps other local political and cultural factors as well. Agency officials 

and program administrators were universal in their assessments of how difficult it was to site new 

programs including permanent supportive housing programs. These challenges have been 

acknowledged in the city's overall housing strategy. In their January 2002 mid-point progress 

report on Leading the Way, Boston's Housing Strategy FY 2001-2003, the city notes the need to 

develop a policy "that would assist in the siting of supportive housing in Boston's neighborhoods." 

They have developed a framework for this policy and are considering a variety of options 

including requiring "that project sponsors demonstrate and document a solid facility management 

track record, financial feasibility in both the development and long-term operational phases, and 

significant (but not necessarily unanimous) community support" (The City ofBoston, 2000). 

The Future--Maintaining and Enhancing the System 

Boston has a fundamental goal of maintaining and strengthening its current homeless service 

system at a time when the funding available to support this system is shrinking. It also wants to 

strengthen its outreach and assessment efforts, increase permanent supportive housing (as part of 

a very broad community-wide housing strategy), and improve coordination and services for 

homeless people with dual diagnoses. Boston is committed to ending chronic homelessness, has 

prioritized programs serving these individuals, has a large, well-established and well-functioning 

continuum of care, and enjoys the support of its political leaders and many mainstream agencies. 

Unlike some other communities, however, it has not decided to tackle chronic street 

homelessness in radically new ways (such as by reconfiguring its shelter system, or adopting 

some of the newer low demand housing strategies). 

Boston is just beginning to incorporate some of the newer approaches. For example, it has 

applied for funding to support a "Housing First" demonstration. During our site visit, we found 

high levels of skepticism to Housing First approaches among service providers. Many street 

outreach workers including healthcare providers working with BHCHP, however, appeared to be 

more supportive of the approach (and harm reduction more generally). 

Boston's current strategies are quite general and rely on existing models ofservice. For example, 

the action steps to address chronic homelessness in the 2003 coe application include activities 

such as "combine data from street outreach workers to compile a master list of the chronically 

homeless and reduce the list by 10 percent each year" and "implement and conduct an additional 

homeless count targeted exclusively to the chronically homeless to enhance Boston's ability to 

track these individuals." Yet with its well-developed continuum of care, innovative groups such 

as the Area A-I Police District Homeless Task Force, and the commitment of mainstream 

agencies such as the state Departments of Public Health and Mental Health, which have invested 

over $31 million in mainstream resources for chronically homeless people, Boston may well 

succeed in reducing its chronically homeless street population with its current approach. 

B.l9 
- -

Appendix B: Boston 

Boston Site Visit Participants 

I I ~ [. I • I ...

Leo Adorno 

Beth Avery 

Jennifer Balboni 

Barry Bock 

Marcy Bouley 

Sarah Ciambrone 

Joe Crispin 

Barry Davis 

Lyndia Downie 

Sue Estes-Shaw 

Carol Fabyan-Takki 

Donna Haig Friedman 

Meghan Goughan 

Eliza Greenberg 

Jim Greene 

Jennifer Greer 

Elisha Harrig-Blaine 

Mary Heafy 

Mary Ellen Hombs 

Jim Hooley 

Gillian Jesty 

Theresa Johnson 

Michelle Kahan 

Michael MacDonald 

Elena Mansour 

- -- • .- - • ,--; I "1- ~ " -

- Pine Street Inn Outreach Programs 

Berkeley YWCA 

Department of Public Health 


Boston Health Care for the Homeless 


Downtown CroSSing Association 

Boston Health Care for the Homeless 

Speak Up 


Friends of the Shattuck Shelter 


Pine Street Inn 

Department of Mental Health Homeless Outreach Team 

Project SOAR/Safe Harbor 

McCormack Ins!. Center for Social Policy 

Pine Street Inn 

Emergency Shelter Commission 

Emergency Shelter Commission 

Emerson College 

Ecclesia Ministries 

CWS Project Independence 

Massachusetts Housing and Shelter Alliance 

Boston Emergency Medical SeNices 

Friends of the Shattuck Shelter 

Friends of the Shattuck Shelter, Transition to Independent Living I & I 

McCormack Ins!. Center for Social Policy 

Tri-City Mental Health 

City of Boston - Supportive Housing 

B.20 
Appendix B: Boston 

Bill MCCARRISTON CWS Project Independence 

Margaret McDonough Tufts-New England Medical Center 

Sharon Morrison Boston Health Care for the Homeless 

John Nolan Veterans' Transitional Program 

Jim 0 ' Connell Boston Health Care for the Homeless 

Sue Pacheco Friends of the Shattuck Shelter, Transition to Independent Living I & " 

Judy Parks YWCA Boston 

Bill Silvestri McCormack Ins!. Center for Social Policy 

Fred Smith MAP/Next Step 

Nancy Sullivan McCormack Ins!. Center for Social Policy 

Stacy Swain Boston Health Care for the Homeless 

Bob Taube Boston Health Care for the Homeless 

Julia Tripp McCormack Ins!. Center for Social Policy 

Beverley Waring Tri-City Mental Health 

Rich Weintraub Project SOAR/Safe Harbor 

Linda Wood-Boyle HomeStart 

B.21 
Appendix B: Boston 

Boston Acronyms 

AMI 

BEST 

BRA 

BHCHP 

BPD 

BRA 

CDBG 

CSPTech 

DHHS 

DMH 

DPH 

DND 

DTA 

DVS 

ESC 

EMS 

HOME 

HOT 

HPC 

SHPG 

Area Median Income 

Boston Emergency Screening Team 

Boston Housing Authority 

Boston Health Care for the Homeless Program 

Boston Police Department 

Boston Redevelopment Authority 

Community De\Lelopment Block Grants 

Connection, Service and Partnership through Technology 

Department ofHealth and Human Services 

Department of Mental Health 

Department of Public Health 

Department of Neighborhood Development 

Department ofTransitional Assistance 

Department of Veterans Services 

Emergency Shelter Commission 

Emergency Medical Services 

Home Investment Partnerships Program 

Homeless Outreach Team 

Homeless Planning Committee 

Strategic Homeless Planning Group 

B.22 
APPENDIX C: COLUMBUS 


'Columbus-Brief Description 

With its pOjulation of 711,470, Columbus is the largest city in Ohio, and the 15th largest city in 

the nation. With its blend of government, education, and private sector employers, Columbus is 

well known for its diverse, well-balanced economy, one that is more resistant to business 

downturns than other areas dependent on a single business sector or industry. Central Ohio has 

added 196,000 new jobs to its economy since 1990, and the Columbus metropolitan statistical 

area enjoys the lowest unemployment rate of any metro area in Ohio, one below the state and 

national rates. 

Despite these strengths, the economic downturn of the last few years and a lack of affordable 

housing have meant that homelessness remains an ongoing problem in Columbus. The city has a 

poverty rate of 13.4 percent, higher than the national average oflO.9 percent. 10 An estimated 

175,000 people in Franklin County are in families with incomes too low to meet even basic 

living costs, and wages are not keeping pace with rising housing costs. Less than 20 percent of 

rental units are within the fmancial reach of low-income households. In 1997, a full-time worker 

had to earn $9.53 an hour in order to afford a two-bedroom apartment, but the same apartment 

required a wage of $15.1 0 in 2002. A Columbus resident earning minimum wage ($5.15 per 

hour) needs to work 63 hours per week just to afford the average rent for a studio apartment. II 

Further complicating matters, the number of units operated by the public housing authority has 

dropped 20 percent during the last seven years, between 30 and 40 percent of people with 

Section 8 vouchers/certificates cannot find a place to live within the l20-day time frame, and 

over 6,000 households are on waiting lists for public housing (Community Shelter Board, 200 I). 

To better understand how Columbus is ending chronic street homeless, we conducted a site visit 

there on April 3-4, 2003 . As part of this visit we interviewed 20 people from agencies providing 

housing, health and mental health, substance abuse treatment, and case management services in 

addition to the staff from the local public housing authority and the Community Shelter Board 

(CSB). We toured several programs providing permanent supportive housing along with an 

engagement center, which takes in public inebriates, and itsassociated substance abuse treatment 

program. A complete list of people interviewed during the site visit is included at the end of this 

appendix. While in Columbus, we also conducted a focus group with eight formerly homeless 

men who have been stably housed for at least six months. 

9 2000 General Demographic Characteristics for Columbus Ohio, 

http://factfinder.census.govlb£llang=envtname=DEC2000SF3UDP3geoid=J6000US39JSOOO.html, 

2000 General Demographic Characteristics for Franklin County, Ohio, 

http://factfinder.census.govlb£l_lang=en_vt_name=DEC_2000_SF3_U _ DP3~eo_id=05000US39049 .html. 

10 2000 poverty statistics for Columbus, 

http: // factfmder.census.govlb£lJang=en_vt_name=DEC_2000 SF3_U_DP3~eo_id=J6000US39ISOOO.html; for 

United States, 

http://factfmder.census.govlb£l_lang=en_vt_name=DEC_2000_SF3_ U _ DP3_geo_ id=OI OOOUS.html. 

II National Low Income Housing Coalition, www.nlihc.org. 

C.I 
Appendix C: Columbus 

For this chapter we obtained information from telephone interviews conducted before and after 

the site visit, individual and group interviews conducted during the site visit, written material 

provided by agencies that partner with the Community Shelter Board, and information garnered 

from agency websites and the Columbus and Franklin County Continuum of Care application. 

Practices of Potential Interest to Other Jurisdictions 

• 	 The Community Shelter Board. The Community Shelter Board (CSB) is really at the 

heart of the homeless service system in Columbus, and its independence, strength, and 

vision are what make initiatives such as Rebuilding Lives possible. (For more 

information, see the Community Shelter Board's website at www.csb.org.) 

• 	 Rebuilding Lives and the Rebuilding Lives Funder Collaborative. Rebuilding Lives 

is a comprehensive and ambitious initiative that represents a "paradigm shift" in the 

community's approach to homelessness. In addition to providing Columbus with a welldeveloped vision and goals, the initiative included a very concrete mechanism for 

funding and monitoring the plan. The Funder Collaborative is clearly a key element of 

the initiative's success to date. (For more information, see the Community Shelter 

Board's website at www.csb.org.) 

• 	 Good Neighbor Agreements and Community Relations. In addition to making very 

persuasive moral and cost arguments in support of Rebuilding Lives, the Community 

Shelter Board has developed very real tools (agreements) to ensure that local 

neighborhoods can control and have input into what's happening in their community. The 

Good Neighbor Agreements, the process used to secure these agreements, and the support 

services themselves have all been key to gaining the support of the community at large. 

(For more information, see the Community Shelter Board's website at www.csb.org.) 

• 	 Data/documentation. The Community Shelter Board's ability to produce reliable up-todate data on their system (who is being helped, how, and at what cost) is very impressive. 

These data are not necessarily part of their HMIS system, which is still in development, 

but they allow the community to evaluate the HMIS data. Accurate and reliable data have 

been key to securing the support of "investors," elected public officials, and the 

community at large. (For more information, see the Community Shelter Board's website 

at www.csb.org.) 

• 	 Sunshine Terrace. Sunshine Terrace is a very interesting partnership between 

Colwnbus' public housing authority (CMHA) and a local social service agency (the 

YMCA of Central Ohio). The two agencies joined together and with the help ofCSB, 

established a Rebuilding Lives pennanent supportive housing program within an existing 

public housing high-rise. In doing so, they were able to provide the community with 65 

units of permanent supportive housing, offer Rebuilding Lives supportive services to all 

of the other public housing tenants in the 180-unit building, dramatically increase the 

occupancy rate of the building (and the neighborhood's acceptance of the building and its 

tenants), and save the building from being closed down and lost to people in need of 

public housing. (Contact person: John Hahn, Deputy Director, CMHA at 614.421.6400.) 

C.2 
Appendix C: Columbus 

Primary Contact Person 

The primary source for more infonnationon the Columbus site is the Community Shelter 

Board's website at www.csb.org. 

History and Context-How the Current System Evolved 

The lead agency for the homeless service system in Columbus is the Community Shelter Board, 

an independent nongovernmental nonprofit agency founded in 1986 by a group of civic leaders, 

business associations, local government leaders, and representatives from a variety of 

foundations. CSB does not provide any direct services within community, nor is it an original 

source of money for homeless assistance services. Its main responsibilities are resource 

development and investment, service delivery coordination and planning, program 

accountability, and systems change and public policy reform. 

The Rebuilding Lives initiative grew out of a request to CSB by the City of Columbus in August 

1997 for a plan to address the needs of people experiencing housing crises who were being 

affected by the development of the Scioto Peninsula, a riverfront corridor in downtown 

Columbus where many street homeless people congregated. In response to that request, the 

Community Shelter Board, with the support of the Franklin County Board of Commissioners, the 

City of Columbus, and United Way of Central Ohio, established the Scioto Peninsula Relocation 

Task Force, which issued the Rebuilding Lives plan in October 1998. It is interesting to note that 

the letter introducing the Task Force's report is addressed "To the Franklin County Community." 

Columbus views ending homelessness the responsibility of the entire community, not some 

smaller group such as the Community Shelter Board, homeless service providers, or elected 

officials. 

The two-pronged strategy at the heart of the plan (emergency housing for those in crisis and 

supportive housing for those with long-term needs) was largely a response to the fact that 

chronically homeless people (a group that accounts for only 15 percent of all those in need) were 

absorbing the bulk of the community's homeless assistance resources. The Task Force 

recognized that the needs of this high-cost group could be met much more effectively, and at a 

lower cost, by providing them with permanent housing with supportive services. At the core of 

the plan is a commitment to provide 800 units of stable supportive housing programs for 

homeless individuals with long-term needs. Table C.l is drawn from the Task Force's initial 

report. 

With these figures in mind, the Community Shelter Board, along with many providers and 

funders, launched the initiative in July 1999. 

C.3 
Appendix C: Columbus 

Table C.1 


Per-Bed Costs for Operations and Services of Franklin County Service Systems 


Used by Homeless Men with Long-Term Needs 


Service System Annual Cost 

per Bed 

Daily Cost 

per Bed 

Service-Enriched Housing $13,000-14,000 $36-38 

Minimum Security Misdemeanor Jail $ 21,188 $58 

Sub-acute Medical Detox $ 69,800 $191 

State Psychiatric Hospital $172,900 $482 

Hospital Inpatient $396,025 $1 ,085 

Sow-ce: "Report of the SCIOto Penmsula RelocatIOn Task Force," Fmal Report October 1998, drawing on 

data from the Ohio Department of Rehabilitation and Corrections; Columbus Health Department; Ohio 

Department of Mental Health; Maryhaven; and the Community Shelter Board. 

Because of its autonomy and independence, the Community Shelter Board can represent the 

homeless service system "as a whole" and can distance itself (somewhat) from the internal 

struggles common to local homeless coalitions. In response to several questions about how it was 

able to effect a given change or make something happen, the executive director simply 

responded "we're not a coalition" (meaning it had the ability and authority to make final 

decisions, including ones that may not have been popular in the provider community). Another 

advantage is the consistency CSB has brought to the community: the homeless service system 

has high staff turnover but not CSB. Finally, it focuses on solutions-calling meetings around a 

single or a short list of problems-and provide "consistent, gentle advocacy." As one state 

senator reportedly noted, he counts on the Community Shelter Board to "clearly state the 

community's needs, be fact-based, and even-handed." 

It is also important to note that while an initiative such as Rebuilding Lives could be replicated in 

other communities, it has a great deal of community support and political backing. The executive 

director of the Community Shelter Board explained that both Columbus and Franklin County 

have highly committed elected officials and the community has a long-standing tradition of 

caring about people, not just homeless people. The message is "bipartisan and very moderateyou don't have to support us because you like homeless people, you can just not like homeless 

people on the street in front of your business." Also, the business and political leadership 

mentors itself and ensures that this tradition of caring for and helping others continues over time. 

It is unclear how well an effort such as Rebuilding Lives-an initiative that is in many ways a 

"paradigm shift"-would have fared without CSB orchestrating the change. Service providers in 

the community generally agreed that CSB is a unifying factor, and while they acknowledged the 

challenges associated with having fewer resources at a time when there are increasing needs, 

they generally characterized CSB as being fair and inclusive. 

C.4 
Appendix C: Columbus 

Approach to Chronic Street Homelessness 

The Community Shelter Board currently allocates $6.2 million annually to 17 partner agencies 

for programs serving homeless individuals and families in Columbus. 12 As part of its work it 

orchestrates the community's main strategy for ending chronic homeless ness embodied in an 

initiative known as "Rebuilding Lives." A summary of the many agencies involved in the 

Rebuilding Lives initiative (and the services they provide) is shown in Table C.2. The rows 

depict each agency and the columns represent the types of services offered by the agency. 

The Rebuilding Lives supportive housing initiative is targeted at people who meet all three of the 

following eligibility criteria: 

• 	 are disabled by anyone or a combination of multiple special needs that substantially 

impede the success of obtaining or maintaining housing, such as a severe and prolonged 

mental disability, a chronic substance abuse problem, a long-term health disorder, or 

long-term unemployment; 

• 	 are homeless according to the McKinney Act defmition; and 

• 	 have spent at least 120 days homeless or have had at least four separate episodes of 

homelessness. 

The basic goals of the Rebuilding Lives initiative are "to improve the system of care for longterm homeless men and women in Columbus, to meet individual needs to end the cycle of 

homelessness, to work with our neighborhoods, and to provide long-term housing solutions." 

With its emphasis on permanent supportive housing rather than shelter care as a solution to 

chronic homelessness, the plan seeks to provide long-term homeless men and women with more 

stable and productive lives. There is widespread support for Rebuilding Lives including among 

traditional outreach and shelter providers. Providers also agreed that despite a general shortage of 

resources for serving homeless people, Rebuilding Lives was not draining resources away from 

the sheltering system. 

As of April 2003, 355 units of Rebuilding Lives supportive housing were operational in the 

Columbus area, and another 172 units were in development and expected to open within the next 

two years (a total of372 units are expected to be operational by the end of2003). These units are 

part of 10 distinct programs being run by 5 lead agencies in the community. In general, the 

projects have experienced very low turnover in residents (much lower than was expected), 

departures tend to be for "good" reasons such as someone getting a place on their own, and the 

waiting lists for each project are very long. 

12 These agencies are Catholic Social Services, Columbus Health Department, Columbus Neighborhood Health 

Center, Community Housing Network, Faith Mission, Friends of the Homeless, Gladden Community House, 

Homeless Families Foundation, Jewish Family Services, Lutheran Social Services, Maryhaven, Salvation Anny, 

Southeast, Inc., Take It to the Streets Foundation, Volunteers of America, YMCA of Central Ohio, and YWCA of 

Columbus. 

C.5 
Appendix C: Columbus 

Table C.2: City of Columbus: Agencies in Reducing/Ending Chronic Street Homelessness 

Homeless-Related Programs and Services 

Nonprofit Programs! Services! Agencies Serving 

Currently or Fonnerly Chronic Street Homeless 

People (listed alphabeticallyl 

(COHHIO) Coalition on Homelessness and 


Housing in Ohio 


Columbus Coalition for the Homeless 
Columbus Neighborhood Health Center 
Community Housing Network 


Community Shelter Board 


Corporation for Supportive Housing 


Faith Mission 
Friends of the Homeless 


Maryhaven 
Rebuilding Lives Funder Collaborative 


Southeast 


Take It To The Streets 


YMCA of Central Ohio 


YWCA of Columbus 

Government Program! Services! Agencies Serving 

Currently or Formerly Chronic Street Homeless 

People 

(ADAM H) Alcohol, Drug, and Mental Health Board 

of Franklin Co. 

Columbus Health Department 

Columbus Metropolitan Housing Authority 

Franklin County Department of Job and Family 

Services 

Ohio Department of Rehabilitation and Correction 

x = Provider 

x 

x x 

x x x X r----­

X I I X XiX x X X 

FIFIFI IFIF X T,F X X X xix 

E E X T,F X X X Ix 

X x XIX X I X 

X XIX X X X 

XIX X XIXIX X X 

F X F X X 

X X XiX X X X X X 

X X X X X 

x X I X I X X X 

F F I F F X XIX x 

X X 

X I X 

X F x X 

x X 

E = Expert TA Provider F =Funder 

C6 
Appendix A: Birmingham 

The JBS MHIMR Authority is a key provider of mental health assessments and care to homeless 

people; it takes referrals from agencies providing other services and works on site at other 

agencies. 

Prevention 

No MBSH members have homeless prevention as a primary focus. However, some agencies 

provide preventive services in the course of their other activities, such as fmancial assistance for 

rent, mortgage, and utility payments; temporary lodging, and homelessness prevention classes. 

Because BHC serves housed as well as homeless households, it is able to assist clients who 

might become homeless if health, mental health, and/or substance abuse crises were not handled 

in a holistic manner. Bread and Roses and PATH operate employment readiness programs to 

ensure that women do not lose housing because of insufficient incomes. An Aletheia House 

outreach worker goes to jails and prisons to help addicted offenders avoid homelessness and 

transition to appropriate community programs. 

State actions have counteracted prevention efforts with respect to people with severe mental 

illness. Between 1985 and the present, bed capacity at the state mental hospital has dropped from 

5000 to 350, with a large drop in the last two years. Not only do local agencies have great 

difficulty in placing potentially street homeless clients in the state facility, but Birmingham's 

street outreach programs report seeing increasing numbers of mentally ill individuals released 

from the state hospital with no plans and no place to go. 

Outreach/Drop-in 

In the late 1990s the Birmingham City Council was considering an ordinance that would have 

banned ''urban camping," clearly aimed at street homeless people in the downtown area. The 

proposal galvanized support for an alternative-active outreach programs to bring people off the 

streets without criminalizing them. Advocates of the ordinance complained that street homeless 

people were creating problems such as panhandling, litter, poor sanitation, and safety concerns. 

Advocates for the homeless population wanted to develop a more constructive and less punitive 

approach. The Mayor created a Task Force on Homelessness to address the issue. 

As an outgrowth of the Task Force, CAP funded an assistance-oriented uniformed patrol. CAP 

officers provide services downtown that range from directing shoppers to stores to helping case 

managers locate homeless individuals when they need to deliver medications or other services. 

CAP prepares pamphlets listing resources by needs with addresses and maps for food, shelter, 

clothing, and employment services. With funding from ffiJD, the CAP Patrol added STOP, a 

street outreach program that teams social workers from the CDM Firehouse Shelter with CAP 

Officers. In addition, the Police Department began employing Community Service Officers, who 

are trained social workers, to do crisis intervention and referrals to shelters and hospitals. The 

Firehouse Shelter increased its own outreach teams' activities to bring clients into its supportive 

housing program or, if the fit was not right, provide them with temporary housing until they 

could be placed in another residential treatment program. The Firehouse Shelter also set aside 

eight beds (four each for males and females) for police referrals. Contributing to this overall 

A. 11 
Appendix A: Birmingham 

effort to provide better outreach to street homeless individuals, the University of Alabama 

Binningham agreed to be the designated Mental Health Emergency Room to meet crisis 

treatment needs. 

Other agencies are also involved in outreach. BHC conducts daily street outreach and also makes 

contacts through its mobile medical units. Hope House does runaway youth outreach from a food 

and clothing van, and Aletheia House has an outreach worker who visits shelters, soup kitchens, 

and the streets to find addicted homeless veterans. 

Low Demand Transitional Residences 

Binningham did not have safe havens or low demand residences at the time of our visit. The 

shelters require residents to be clean and sober and participate in treatment programs, although 

some programs give residents who relapse multiple chances to return and try again. CDM is 

about to open a "safe haven" for dually diagnosed homeless individuals, but this facility is likely 

to require participation in treatment programs and discourage continued substance abuse. 

Emergency Shelters 

The CDM emergency shelter program (50 beds) is noteworthy because it links into CDM's 

transitional housing, which has substance abuse treatment and employment programs. The 

Salvation Army is the largest provider of emergency shelter beds for individuals (139 beds) 

followed by Jimmie Hale Mission (100 beds), but neither of these programs provides transitional 

housing for individuals, and linkages across programs are not made consistently. 

Transitional Programs 

The major transitional programs in Birmingham have, in addition to treatment sessions, strong 

employment and community service components. CDM operates the largest transitional housing 

program (80 beds); the program requires sobriety, but allows participants to return after a 

relapse. Participants have little idle time, as CDM tightly schedules their week with employment 

or employment training (20-40 hours), community service (15-20 hours), and treatment class 

attendance (9 hours). Four members of our participant focus group who had failed other 

programs stated that the greater structure in the CDM program played an important part in their 

recovery. Two other focus group participants thought that the CDM program was too dictatorial, 

and preferred a more self-structured approach that they found in another program. 

BHC, Aletheia House and AIDS Alabama provide transitional housing (40, 18, and 13 beds, 

respectively) that links to their permanent supportive housing programs. Fellowship House is the 

second largest provider of transitional housing (70 beds), providing inpatient residential 

treatment for persons with severe mental illness who are homeless and have a co-occurring 

disorder. But Fellowship House does not have strong ties to the CoC and attends meetings 

infrequently. 

A.12 
Appendix C: Columbus 

In order to be eligible for a Rebuilding Lives unit, an individual must either have been homeless 

on the streets or in shelter for 120 days or more, or have had 4 or more homeless episo_des. Many 

if not most of those in the program have had long histories of street homeless ness. Rebuilding 

Lives tenants are mostly single men (80 percent), most have alcohol and/or drug problems, and a 

large share of these have co:occuning mental illness (a smaller share have mental illness alone). 

Rebuilding Lives offers a variety of housing "models," largely because of the diversity of 

programs and agencies participating in the initiative. There is variation on both the housing and 

services-sides of the effort. Rebuilding Lives housing includes scattered site and Single Room 

Occupancy (SRO) high-rise housing, public housing, and Section 8-based housing. Service 

approaches range from "clean and sober," to "stages of change," to low-demand "harm 

reduction" models. 13 Yet others use psychiatric models of care. In all Rebuilding-Lives 

programs, services are optional and the housing is not time-limited. 

Mainstream Involvement 

The original 1998 Rebuilding Lives plan envisioned a major role for mainstream agencies, which 

were already heavily invested in combating homelessness. The Community Shelter Board 

recently reviewed the roles of key collaborators as described in the original plan to assess how 

well they were doing. The results of this review are reported below in Table C.3. The table is 

interesting for several reasons. First, it illustrates the wide variety of agencies that playa major 

role in Rebuilding Lives; second, it details exactly what the plan expects of each agency; and 

third, it shows that plans can fall short of reality. In some cases, what was expected of an agency 

simply "did not occur" or was "determined to be not feasible." Finally, it is worth noting that the 

roles are not limited to providing funding or other resources to the initiative: they include things 

like identifying appropriate housing stock, providing technical assistance, and taking on 

leadership roles. 

In general, most of the key collaborators are "at the table" and are meeting or exceeding their 

original roles. Some Federal agencies, such as Veterans Affairs and the Social Security 

Administration, are "cooperative but not collaborative." In other words, it has taken a lot of work 

to get them to participate and they appear to be willing to do things but tend not to do them in a 

timely manner. It is not clear why this is the case, it may be the result of cultural differences 

between agencies/organizations but it is often simply a function of the interests and 

commitments of who heads the agency. As the Executive Director of the Community Shelter 

Board noted, it also takes resources (meaning time and money) to build relationships with other 

(mainstream) agencies, to understand their internal bureaucracies and how they think about 

people and problems. 

13 The "harm reduction" programs have the longest waiting lists. Also, the Community Shelter Board does not 

intend to fund any additional "clean and sober" models as part of Rebuilding Lives. 

C.7 
Appendix C: Columbus 

Table C.3: Roles of Key Collaboratorsl4 

1998 Rebuilding Lives Plan 

City of Columbus 

Capital grants consistent with plan and priorities 

Commit General Revenu'e Funds for Funder 

Collaborative and Shelter Operations 

Adopt Shelter Certification as part of the development 

review proc'ess 

Franklin County 

Commit General Revenue Funds for Funder 

Collaborative and Shelter Operations 

Through Mid-Ohio Regional Planning Commission 

(MORPC), capital grants consistent with priorities and 

plan 

Revenue source for Housing Trust Fund (HTF) 

Community Shelter Board 

Convene the Funder Collaborative 

Fund opera60ns of emergency shelters consistent with 

Task Force plan and priorities 

Fund shelter diversion activities and contract for these 

services on behalf of the Funder Collaborative 

Monitor Task Force plan implementation 

2003 Rebuilding Lives Status Report 

Invested HOME capital funds in supportive housing. 


Invested Community Development Block Grant 


(CDBG) capital in Faith Mission on Sth A venue and 


Harmon A venue shelters. 


Invested additional General Revenue Funds, HOME 


rental assistance and Emergency Human Services for 


supportive housing. 


Maintained flat commitment of funds for shelter 


operations. 


Did not occur. 


Invested additional General Revenue Funds and 


Temporary Assistance for Needy Families (TANF) for 


supportive housing. 


Maintained commitment of funds for shelter 


operations, cost of living increases through 2002. 


Invested in building of the Engagement Center. 


Created new Community and Economic Development 


Department. 


Invested HOME capital funds in supportive housing. 


HTF not created for supportive housing. 


HTF created with City of Columbus to address 


affordable housing. 


Facilitates the Collaborative, which has met monthly 


since inception. 


Invested additional private funds in emergency 


shelters. 


Invested additional state and private funds in homeless 


prevention and street outreach. 


Issues annual report to funders as well as periodic 


updates. 


ADAMS (The Alcohol, Drug and Mental Health Board of Franklin County) 

Take lead on development of Crisis Stabilization 

Program 

Put resources into Funder Collaborative 

Get funded agencies to the table and focused on the 

plan 

Led development of the Engagement Center. 

Invested in the operations and services provided at the 

Engagement Center. 

Invested services funding in supportive housing. 

Several ADAMH agencies are active partners in 

supportive housing. 

14 This is drawn from pp. 10-11 of Community Shelter Board, "Moving Forward, March 2003, Rebuilding Lives: 

Breaking the Cycle of Homelessness," Columbus, Ohio, 2003. 

C.S 
Appendix C: Columbus 

1998 Rebuilding Lives Plan 

Corporation for Supportive Housing 

Put resources into Funder Collaborative 

Assist with development of capital fmance packages 

for housing 

Teclmical assistance and project development capacitybuilding 

Support to Funder Collaborative 

CMHA (Columbus Metropolitan Housing Authority) 

Identify housing stock that can be reused as part ofthe 

system (surplus units, assets, Sunshine, scattered site 

and small projects) 

Identify units in the HUD portfolio that could be reused 

as part of the system 

Implement program for Section 8/employment linkage 

Reallocate Shelter Plus Care to provider agencies that 

can maximize their use 

Veterans Services Commission 

Put resources into Funder Collaborative 

Get V A and other veterans organizations to the table 

and focused on the plan 

2003 Rebuilding Lives Status Report 

Provided operating grant for supportive housing 


through Hilton Foundation. 


Provided as needed due to the level of experience and 


knowledge of providers thus far. 


Provided direct fmancial assistance to sponsors and 


teclmical assistance to develop capacity. 


Provided administrative support to Collaborative. 


Implemented-partnership at Sunshine Terrace. 


Determined to be not feasible. 


Invested substantial Section 8 (tenant and project 


based) for supportive housing. 


Determined to be not feasible. 


Did not occur. 


V A participates in one project. 


Franklin County Department of Human Services (now Job and Family Services) 

Provide T ANF funds to CSB for families to enable 

CSB to free up resources to contribute to Funder 

Collaborative 

Franklin County Office on Aging 

Put Senior Options resources into Funder Collaborative 

United Way 

Put resources into Funder Collaborative 

Get funded agencies to the table and focused on the 

plan 

Provide leadership to build business and community 

support for implementation of the Task Force plan . 

Other Philanthropic Organizations 

Put resources into Funder Collaborative 

Capital grants consistent with plan and priorities 

Provide leadership to build business and community 

support for the Task Force plan 

Provided 3 years of support through 6/30/02. 

Did not occur. 

Invested in capital, operations, and services for 

supportive housing. 


Several United Way Columbus (UWCO) agencies are 


active partners in supportive housing. 


Housing Vision Council and board of trustees provided 


leadership from business community and consider 


Rebuilding Lives to be a strategic initiative ofUWCO. 


Multiple foundations, businesses and individuals have 


invested in capital, operations, and services for 


supportive housing. 


Capital grants provided for the new Faith Mission on 


8th Avenue and multiple supportive housing projects. 


Columbus Foundation and Columbus Medical 


Association Foundation are active members of the 


Funder Collaborative. 


CSB Trustees and Advisory Council provided business 


and community leadership to the initiative. 


C.9 
Appendix C: Columbus 

Selected System Components 

Effectively addressing homelessness, including chronic homelessness, requires many different 

types of services and system components. These range from street outreach efforts to any of a 

variety of housing programs, as well as supportive services and homelessness prevention. In 

general, outreach and drop-in programs (and intake and assessment services) are the gateway 

into housing for homeless individuals, but Columbus has a very open shelter system and many 

people living on the streets (or "on the land" as they say in Columbus) have in fact touched the 

shelter system at some point in time. Although it is possible to obtain permanent supportive 

housing through self-referral, formerly homeless individuals indicate that it is extremely difficult 

to get in without some type of caseworker advocating on their behalf. 

Once connected with the system, clients with short-term emergency housing needs are provided 

emergency (and possibly transitional) shelter, and then move back into permanent housing in the 

community. Clients with longer-term needs are provided permanent supportive housing or 

permanent subsidized housing without supportive services. In many cases, they move directly 

into permanent supportive housing from the streets. Note that the Community Shelter Board is at 

the center of this system and connects directly with each component. 

Most of the individuals interviewed as part of this study reported that there are no maj or gaps in 

Columbus' system, but that "more of everything is needed." Several people added that there can 

be very long waits (lasting many months) for mental health services after an initial contact is 

made through NetCare Access (ADAMH' s 24-hour emergency response by phone, on-site, or 

through mobile services). Another observer pointed out that the primary access point to mental 

health services is not through ADAMH but through the shelter system. Yet others added that the 

many outreach programs in Columbus are only just beginning to coordinate with one another. 

Below, we briefly review the many components that comprise Columbus' homeless service 

system. 

Prevention 

Homelessness prevention is a major component of Columbus' ten-year plan to end chronic 

homelessness. Prevention efforts include both improved housing retention/stability and primary 

prevention through better discharge planning with the Ohio Department of Rehabilitation and 

Corrections (ODRC) and the mental health system. 

Lutheran Social Services is the lead agency in the Homelessness Prevention Program. Services 

provided include assistance with rent, mortgage and utility payments, mediation, budget 

counseling, employment leads, assistance with housing searches, and linkages to other 

community resources. These programs are funded with resources from the Community Shelter 

Board, the Federal Emergency Management Administration, and the State of Ohio Adult 

Emergency Assistance Program. 

In addition to ensuring that all homeless people are properly connected to the Franklin County 

Department of Jobs & Family Services (FCDJFS) and ADAMH systems, the Community Shelter 

Board has entered into a collaborative agreement with the ODRC to reduce discharge to shelters 

or the streets. The state has made reforms, known as the Ohio Plan, to improve how inmates are 

C.lO 
Appendix C: Columbus 

discharged from ODRC facilities, and Franklin County is one of three counties in Ohio 

participating in a special initiative knovro as the Core Plan that targets discharge and other 

enhanced services to high-risk inmates. In general, the community reports that they have good 

discharge policies in place and CSB has established good working relationships with ODRC, but 

there is now a need to "bring practice in line with the policy." 

Outreach and Drop-in 

The Community Shelter Board currently contracts its outreach services with one agency. 

Specialized teams target their outreach activities toward homeless persons with specific needs 

such as serious mental illnesses. ADAMH also funds a van (the NetCare van) whose staff 

members take public inebriates to Maryhaven's Engagement Center for sobering services. Even 

though this service is voluntary, the alternative can be spending the night in jail. Another agency 

uses Projects for Assistance in Transition from Homelessness (PATH) fund to enhance its · 

outreach team with a behavioral component consisting of a psychiatrist, a nurse, a chemical 

dependency counselor, and a case manager. This team of professionals travels to encampments 

and other gathering spots for homeless individuals by van, enabling it to provide immediate 

services and referrals. 

The Columbus Homeless Coalition sponsors the Outreach Cluster, comprising six agencies that 

perform outreach activities together on a weekly basis. Their function is simply to locate 

homeless individuals, gain their trust through the engagement process, and connect them to 

services. However, they may not be able to follow up with their clients after making initial 

appointments; delays of as much as four months are not unusual. 

Outreach services appear to be duplicative. Even though the groups from the Outreach Cluster 

are aware of the groups from the Community Shelter Board, they frequently conduct their 

activities in the same areas. One observer reported that on a single afternoon three separate 

agencies provided outreach services in the same homeless encampment. Current efforts are 

underway to reduce duplication of services and increase collaboration by convening monthly 

meetings among all outreach providers. It also appears that many outreach programs have their 

own orientation/outlook on homeless people, one that is not always consistent with bringing 

people in off the streets. Many outreach workers are most interested in helping people "survive 

on the streets," and may have their own mistrust of mainstream agencies. Having a coordinated 

outreach system (with a single point of contact, a shared data system, etc.) is a goal but not yet a 

reality in Columbus. 

Emergency Shelters 

A clear point of entry into Columbus' homeless service system is through one of its emergency 

shelters or through Maryhaven's Engagement Center. Emergency shelters provide no-cost, shortterm housing, usually with a maximum stay of 90 days. Beyond providing a secure clean place to 

sleep, emergency shelters also give access to basic services such as showers, meals, healthcare, 

and material assistance. Many emergency shelters also provide case management services 

including assessments and linkages to mainstream service providers, mental health and substance 

Cll 
Appendix C: Columbus 

abuse treatment services, medical care, and employment services. The total shelter capacity for 

adults is 464 beds, of which 317 beds are contracted through the Community Shelter Board. 

The Maryhaven Engagement Center provides overnight accommodations and services for male 

and female public inebriates. Clients can remain in the Engagement Center for three days 

without receiving substance abuse treatment or ten days if they participate in Maryhaven's 

outpatient detoxification program which is right next door. Individual inebriates, nowever, can 

be admitted to the engagement center as often as needed. The usual stay is for one night. Once an 

individual enters the Engagement Center, attempts are made to engage the individual in 

substance abuse treatment and other services working towards the goal of permanent housing. 

The Engagement Center is funded by the Community Shelter Bo'ard, the ADAMH Board, and a 

HUD save havens grant. It has an overall capacity of 54 beds. 

Interestingly, in a group meeting with many of Columbus' "traditional" shelter providers, there 

was widespread support for the Rebuilding Lives initiative (and most of them said they would 

like to see more of it). While they did not feel that the initiative was pulling resources away from 

their programs, they did note how important it was to preserve the emergency shelter system for 

short-term needs. A variety of circumstances (the September 111b terrorist attacks, a sagging 

economy, etc.) have increased acute homelessness at a time when there are severe downward 

pressures on the job and housing markets. The housing stock continues to dwindle; landlords and 

employers are becoming more selective. 

Transitional Programs 

Columbus has 742 transitional housing beds of which 347 are reserved for individuals. The 

Community Shelter Board currently has no plans to develop additional transitional housing units; 

it is devoting its resources to developing more permanent supportive housing units. The three 

transitional housing programs run by CSB partners offer shelter services, alcohol and drug 

services, and health and employment services, and some of them have substance abusers as their 

primary focus population. 

Permanent Supportive Housing 

The Community Shelter Board contracts with nine programs that together provide 355 units of 

permanent supportive housing through Rebuilding Lives (see Table C.4) other permanent 

supportive housing operates independently of CSB. Project sponsors include non-profit housing 

developers, mental health agencies, and multiple partnerships. Housing ranges from scattered site 

apartments to small SROs to large high-rise apartments (projects ranging in size from 15 to 65 

Rebuilding Lives units). One of the programs, a save haven, has 13 efficiency units combined 

with a drop-in center. 

In addition to developing the housing, project sponsors are responsible for recruiting tenants and 

overseeing the program. Generally, sponsors recruit directly from the shelters and streets, and 

there does not appear to be any collaboration in recruiting for projects among different housing 

providers. The units have seen very low turnover (10-20 percent), so initial rent-up (when new 

C.12 
Appendix C: Columbus 

projects come on-line) is the main way in. There are long waiting lists: one 25-unit project, for 

example, has 100 people on its waiting list. 

Once participants are recruited and given housing, they may remain permanently. All Rebuilding 

Lives programs are "low demand" in that the only requirement is a basic tenant-landlord 

agreement: pay rent, don't disturb the neighbors, and don't destroy the property. Other services 

are generally voluntary but engagement is high: 60 to 100 percent participate, mostly in case 

management, employment, treatment and recovery, and basic life skills. Programs also link 

tenants to mental and physical health services, including local community health centers that also 

help people apply for Supplemental Security Income (SSI), food stamps, etc. Not surprisingly, 

given the variation in how programs are structured and run, service levels can vary from one 

Rebuilding Lives program to another. The services-which tend to be more supportive and 

engaging rather than highly clinical or rigid in nature-help keep tenants housed, contribute to 

their health and employment prospects, and increase their sense of self-worth. Interestingly, the 

executive director of CSB also commented that the exact mix of services is not as important as 

the housing itself, and that the (presence of) services is "as much about getting landlords and 

neighbors to accept you [the program], as it is about benefiting tenants." She also added that 

generally Rebuilding Lives housing "feels like normal housing" rather than "program" housing. 

The official policy of Rebuilding Lives is that all supportive services are voluntary, but there are 

some exceptions. For example, Federal statute requires that tenants benefiting from Shelter Plus 

Care grants meet with a case manager twice a year. Other Rebuilding Lives projects require 

service participationfor admission. The YMCA SRO initially wanted to have mandatory service 

participation/engagement; instead it instituted a 60-day orientation period during which time 

services are mandatory. After 60 days, participants must pay rent so it effectively requires people 

to either receive services or pay rent. As the executive director of CSB explained, through 

Rebuilding Lives many housing providers have had to learn about engagement, and have had to 

relinquish some of the "hammers" (i.e., mandatory requirements such as sobriety, etc.) they were 

accustomed to using and learn other strategies for engaging people. Some traditional shelter 

providers commented that even the older sobriety-based programs in the community were now 

"gentler" as a result of the arrival of "harm reduction" in Columbus. 

CSB's preferred model for permanent supportive housing units is one that combines Rebuilding 

Lives clients with the other clients because it normalizes the living environment. Some sites have 

a 50-50 mix of clients while other sites have a 2: 1 ratio of non-Rebuilding Lives residents to 

Rebuilding Lives residents. The residents who are not part of Rebuilding Lives are able to 

provide support and encouragement for the Rebuilding Lives clients, who are then able to pattern 

their behavior after the mainstream residents. The residents who are not part of Rebuilding Lives 

are also able to access services offered to the Rebuilding Lives residents on a lesser scale so the 

program benefits all residents. 

Rebuilding Lives has led to a number of unique collaborations among community agencies. One 

particularly interesting partnership is that between the YMCA of Central Ohio and the Columbus 

Metropolitan Housing Authority (CMHA). The two agencies jointly entered into an agreement to 

revitalize a public housing high-rise building project (Sunshine Terrace) that had been earmarked 

for demolition. CMHA invested $2 million in physical renovations and improvements and the 

YMCA provides support services (through Rebuilding Lives) and property management. SixtyC.13 
Appendix C: Columbus 

five of the 180 units in the building are devoted to Rebuilding Lives clients, who meet all of the 

criteria for the initiative. This has been a successful collaboration because each partner is able to 

bring a different componentto the table. 

It should be noted that the Columbus Metropolitan Housing Authority's involvement in 

Rebuilding Lives extends far beyond Sunshine Terrace. About 300 of the 350 permanent 

supportive housing units that are part of the initiative have some type of public housing subsidy 

attached to them, including Section 8 (both project- and tenant-based). CMHA is also part of the 

Funder Collaborative and helps with streamlining procedures, interpreting rules as flexibly as 

possible, etc. 

Studies have demonstrated a higher success rate at maintaining housing for clients who receive 

case management services, (U.S. Department of Housing and Urban Development, 1995) and 

both the YMCA and CMHA explain that this is this is anecdotally true at Sunshine Terrace. Case 

managers are able to intervene for tenants if they are unable to pay their rent or to intervene on 

the behalf of management if a tenant's behavior is inappropriate. 

Parsons A venue 

Apartments 

Cassady A venue 

Apartments 

Safe Havens 

Community 

Housing 

Network 

Community 

Housing 

Network 

Community 

Housing 

Network 

25 For the Rebuilding Lives target population with chronic 

alcoholism. This stages of change program is implemented in 

col.laboration with Friends of the Homeless and Southeast. 

II For the Rebuilding Lives target population with substance 

abuse issues. This clean and sober program is implemented in 

collaboration with Friends of the Homeless, Columbus 

Neighborhood Health Center, and the Columbus Health 

Department. 

13 For the Rebuilding Lives population with serious mental 

illness and substance abuse issues. This low-demand program 

is implemented in coUaboration with Friends of the Homeless 

and Columbus Neighborhood Health Center. 

C.14 
• • - - -

- -

Appendix C: Columbus 

~_. . ::1 . '--	 _ 

Scattered Site 	 Community 60 For the Rebuilding Lives population with substance abuse 


Housing issues. This clean and sober program is implemented in 


Network collaboration with Columbus Neighborhood Health Center 


and the Columbus Health Department. 

Sunshine Terrace 	 YMCA of 65 A collaborative between the YMCA, the Columbus 

Central Ohio 	 Metropolitan Housing Authority, and Columbus 

Neighborhood Health Center to provide housing to 65 men 

and women from tbe Rebuilding Lives target population and 

to help stabilize the 180 lll1it high-rise apartment building. 

North High Street Commlll1ity 36 For the Rebuilding Lives target population with severe mental 

Apartments Housing illness or dual diagnosis. This stages of change program is 

Network implemented in collaboration with North Central Mental 

Health Center. 

North 220d Street 	 Commlll1ity 15 A total of 30 supportive housing units, 15 for the Rebuilding 

Housing Lives target population for veterans and tbose with serious 

Network mental illness. This program is implemented in collaboration 

with Columbus Area Mental Health Center and the 

Department of Veterans Affairs. 

Scattered Site 	 Vollll1teers of 15 For the Rebuilding Lives target population with substance 


America abuse issues. 


Permanent Supportive YMCA of 65 Within the YMCA's 40 West Long Street location, 65 units 

Housing at 40 West Central Ohio for Rebuilding Lives target population with mental illness and 

Long Street substance abuse issues. 

Scattered Site Southeast 50 	 For the Rebuilding Lives target population with dual diagnosis 

of mental illness and substance abuse. This low-demand 

program also uses an Assertive Commlll1ity Treatment team. 

~ ~U.L'ti~ ·jl ·jt:-fJ~t!..;JIrrr;i"lli~llc;, 

. , 	 ' . 

Commons at Grant National Church 50 New construction of 100 lll1its, 50 for the Rebuilding Lives 

Residences target population. 

Source: Rebuilding Lives: Supportive Housing Projects, Community Shelter Board, accessed on-line at 

http://www.csb.orgfPublicationsiprojects.html on May 19,2003. 

C.15 
Appendix C: Columbus 

Supportive Services 

Supportive services are available to all residents at facilities housing Rebuilding Lives clients. 

The official policy of Rebuilding Lives is that all supportive services are voluntary. Participation 

is high nonetheless, with about 60-100 percent engagement. Typically, supportive services 

include case management, pre-employment and employment services, substance abuse treatment 

and recovery groups, and basic life skills training. Linkages are also provided to both mental and 

physical health services (in some cases health services are on site) and mainstream agencies 

providing SSI and welfare. The executive director of CSB observed "there is no good way of 

getting people access to SSI and Medicaid" (to the extent that they are eligible for these). This 

has not been a priority until quite recently. 

Supportive services are also available to those who are not in permanent supportive housing. 

They can be obtained through the shelter system, through ADAMH, the FCDJFS, the 24-hour 

information and referral line, and referrals from churches, hospitals and clinics, law enforcement 

agencies, and schools. 

It should be noted that there has been, and continues to be, some resistance in the provider 

community to the "housing first" model. CSB has tried to educate providers, and convince them 

that they do not need to rely on the old tools of coercion, such as threats of eviction, to manage 

people. When asked how they have overcome the resistance, CSB simply responded, "We're not 

a coalition. We write the roles." CSB has also made the moral argument that it's time for them 

(meaning chronically homeless people) to "move to the front of the line." 

As part of our site visit to Columbus, we conducted an in-depth focus group discussion with 

residents of three Rebuilding Lives programs. All were men who had spent long periods of time 

homeless on the streets of Columbus. Support and appreciation for the program was universal. 

Some participants noted that while their needs were being met, they still had to make an effort to 

benefit from the supportive services, while another one said that one can become complacent 

because "all this stuffs been given to me." When asked about the importance of the supportive 

services and staff, another person noted that if you need (want) the help, then it's important that 

it's there and he's glad it's there, but "otherwise the day just goes on." They all agreed that these 

types of programs and supportive housing programs would greatly benefit their friends and 

others who were still living on the land. There was widespread uncertainty about how exactly 

one gets into a Rebuilding Lives program. Participants commented that they just "stumbled in on 

this," or a caseworker "happened to know about it" and helped them (four participants came into 

their program directly from the streets while others had been in shelter). Many participants noted 

that without the program they would be drinking and drugging on the streets and would probably 

be dead. One respondent commented that program should be called "Saving Lives" rather than 

Rebuilding Lives, because that is what it has done for him. 

Affordable Housing 

Affordable housing is a significant problem in Columbus as it is in many communities across the 

nation. Only 17.6 percent of all housing units in Columbus are identified as being within 

financial reach of low-income households and only 67 percent of the scattered site rentals have 

affordable leases. As mentioned earlier, a person earning minimum wage in Columbus would 

C.16 
APPENDIX A: BIRMINGHAM 


Birmingham-Brief Description 

Binningham, with a 2000 population of 242,820, is the largest of 30 municipalities -in Jefferson 

County, Alabama and comprises a little more than one-third of the county's total population. i In 

the 2000 Census Birmingham's poverty rate was 24.7 percent and Jefferson County's was 14.6, 

both higher than the nation's 11.3. Jefferson County's 2002 unemployment rate was 4.4 percent 

compared to the nation's 5.8? Given the city's poverty rate, its unemployment rate is likely 

higher than the county's, and higher than that of the nation. 

Among the communities included in this study, Birmingham is unique in having almost no state 

or local public dollars invested in its homeless assistance network, including its efforts to end 

chronic street homelessness. Public agencies involved in homeless-related services in 

Binningham are those that rely primarily on Federal funding, including the Birmingham 

Department of Community Development, the Department of Veterans Affairs, the Jefferson 

County Housing Authority, and the Jefferson-Blount-St. Clair (JBS) Mental HealthlMental 

Retardation Authority. Further, income and other eligibility criteria for Medicaid are so stringent 

that very few people qualify, so in Birmingham Medicaid is not the important resource for 

funding supportive services that it is in many other communities. 

Against this backdrop, Birmingham providers and advocates have developed some interesting 

responses to homelessness. The entity orchestrating most of the homeless network planning and 

development is Metropolitan Birmingham Services for the Homeless (MBSH), a membership 

organization with no formal authority or control over its members. Agencies have developed 

some innovative ways to blend the interests of property owners and poor people to create 

affordable housing with very little government funding, and have involved the business 

community in other ways to address street homelessness. 

The network of programs and services developed to encourage people to move from the streets 

into housing includes outreach, emergency shelter, and transitional and permanent supportive 

housing. A safe haven is expected to open in December 2003. Employment and community 

service are important emphases in programs working with people whose homelessness is 

complicated by chronic substance abuse. On our visit to Birmingham on May 7 and 8, 2003, we 

interviewed 17 people and attended the monthly MBSH meeting with many others. The people 

interviewed represented county and regional agencies; nonprofit outreach, drop-in, shelter, and 

housing providers; and agencies serving homeless people through casework, mental health and 

substance abuse treatment, health care, and employment services. People who had experienced 

1 http://www_census.gov/prodl2002pubsiOOccdb/ccOO_labCI.pdf. 


2 2000 poverty statistics for Birmingham, http://censtats.census.gov/cgi-bin/pctlpctProfile_pl; 2000 poverty 


statistics for Jefferson County, www.census.gov/prodl2002pubsiOOccdb/ccOO_tabBS .pdf; for United States, 

quickfacts.census.gov/stateslOOOOO_html; February 2003 unemployment statistics for Birmingham MSA, 

bttp://data_bls.gov/cgi-binlsurveymost; for United States, www.bls.gov/cpslhome.htm#overview. 

A.I 
Appendix A: Birmingham 

chronic street homelessness were included in a separate focus group. A full listing of persons 

interviewed, other than focus group participants, may be found-at the end of this appendix. 

Practices of Potential Interest to Other Jurisdictions 

In Birmingham we found several practices for reducing chronic street homelessness that may 

have applications for other communities: 

• 	 Expanding Heath Care into a Total Continuum of Care. Birmingham Health Care 

(BHC) has grown from providing health, substance abuse, and mental health services for 

homeless people into a multi-faceted agency doing outreach, case management, 

transitional housing, and permanent supportive housing for homeless people as well as 

myriad services for housed poor people. As a health service agency that went on to 

provide housing for its clients, BHC had the advantage of already having a very strong 

service component in place to go with its housing. Being one agency helps BHC provide 

prompt and unbroken services to homeless individuals and integrate their case 

management and service records. (Contact person: Jonathan Dunning, Chief Executive 

Officer, JWDunning@cs.com, 205.439.7201.) 

• 	 Requiring Employment and Community Service in Substance Abuse Treatment 

Programs. In addition to 9 hours of treatment sessions, the Firehouse requires that 

participants work and perform 15 to 20 hours per week of community service. In focus 

groups, successful participants said that employment was a start toward economic selfsufficiency and that community service improved their self-concept. All the major 

programs in Birmingham focused on street addicts have significant employment 

components, including BHC, Aletheia, and First Light, in addition to Cooperative 

Downtown Ministries (CDM). (Contact person: Steve Freeman, Executive Director, cdmshelter@prodigy.net, 205.252.9571.) 

• 	 Using Building Donations and Other Private Resources. Birmingham housing 

providers have been successfully soliciting donations of dilapidated buildings from the 

private sector. Sponsors help fund rehabilitating building units and program participants 

learning construction trades help do the work. The neighborhoods are improved and the 

donor receives a tax write off. The Birmingham Continuum of Care is developing its 

HMIS using private donations so that it does not drain funding away from other programs 

being proposed in Birmingham's applications to HUD. (Contact person: Chris Retan, 

Executive Director, Aletheia House, Chris_Retan@yahoo.com, 205.324.6502.) 

• 	 Using a Powerful Volunteer Association to Spearhead a Continuum of Care. In an 

environment of little local government funding, Metropolitan Birmingham Services for 

the Homeless (MBSH) has emerged as a powerful volunteer coordinating body even 

though it has no formal authority or controls over its members. MBSH helps government 

agencies, nonprofits, and the private sector work together to create affordable housing 

and provide other services to address street homelessness. (Contact person: Michelle 

Farley, Acting Director, -Metropolitan Birmingham Services for the Homeless, 

Metropolitan Birmingham Services for the Homeless, mmfarley2003@yahoo.com, 

205.254.8833.) 

A.2 
Appendix C: Columbus 

need to work 63 hours per week to afford a studio apartment. The Community Shelter Board 

identifies a deficit of approximately 22,000 housing units a\'-ailable to extremely low-income 

individuals. Additionally, the Continuum of Care application identifies a gap of over 1,000 beds 

for homeless individuals. 

Columbus has several groups committed to addressing the problems associated with affordable 

housing. IS Among others, they include: 

• 	 The United Way Housing Vision Council is a group of 30 individuals representing 

donors, consumers, neighborhood groups, United Way Board of Trustees and agencies, 

and local experts working together with the common purpose of iaentifying and 

achieving the results necessary to address the community's most critical housing needs. 

• 	 The Columbus Compact is the lead agency in developing and focusing resources in 

central city neighborhoods while encouraging collaboration in neighborhood 

development and central city policy issues. 

• 	 The Columbus and Franklin County Affordable Housing Trust Corporation combines 

private and public funds to fmance the development of affordable housing, including 

rental housing, within the city. 

• 	 The Building Responsibility, Equality, and Dignity (B.R.E.A.D.) Organization is an 

interfaith coalition that addresses core issues pertaining to housing in addition to crime, 

safety, jobs, and education. 

• 	 The Franklin County Housing Advisory Board makes recommendations to the County 

Commissioner for bonds aimed at expanding and preserving the supply of affordable 

rental housing in Columbus and Franklin County. 

• 	 The ADAMR Board collaborates with the Community Shelter Board to create permanent 

supportive housing for homeless individuals. 

Documenting Reductions in Chronic Street Homelessness 

Columbus has not conducted many street counts of its homeless population, but it has an "open 

shelter" system and most people homeless on the street "touch" the shelter system at some point 

(even if it is just through the winter overflow shelters). As a result, CSB has a good sense of the 

size of its street homeless population based on its shelter data. There are between 150 and 250 

people homeless on the streets of Columbus on a given day, and no more than 1,000 individuals 

homeless on the streets throughout the year. They have yet to document reductions in their street 

population as a resul t of Rebuilding Lives, although the program is clearly succeeding in housing 

long-term chronically homeless individuals for long periods of time. 

15 Columbus and Franklin County Continuum of Care Narrative, 2002, pp. 3-4. 

C.17 
Appendix C: Columbus 

The Community Shelter Board does collect data on each individual served by its partner 

agencies. CSB has used an HMlS since 1990 and has been using Service Point since 2001. 

Currently CSB is able to use Service Point to measure impact at the individual program level 

only. Measures include average monthly occupancy, length of residence, reasons for departures, 

numbers returning to shelter, etc. The system can support analyses of long-term recidivism 

(looking at any time period of interest, for example, 3, 6, 9, or 12 months). Again, because of 

their "open shelter" model, the community's shelter data are likely to reveal if someone who has 

left permanent supportive housing has returned to the streets. There are also some limited street 

outreach data (from the primary outreach providers) that have been part of the HMlS since April 

2002. 

Some agencies intervi-ewed expressed frustration and difficulties with using Service Point. The 

difficulties centered on consistency of data input between workers, mostly associated with high 

staff turnover and problems generating reports. At least one agency tracks data in duplicate to 

assure accurate reporting. The Community Shelter Board convenes monthly HMlS 

administrative meetings at which the agencies can bring problems and request technical 

assistance. 

Existing shelter data indicate a 7 percent decrease in the total number of clients sheltered in 2001 

as compared to 1998 (note these are all homeless clients, not just those who are chronically 

homeless). Of the 2,959 clients sheltered in 2001,298 had successful outcomes, meaning they 

exited the shelter system to either permanent or transitional housing. The average length of stay 

during this period of time remained relatively stable for men, while it increased by over 20 

percent for women, increasing from 37 days in 1998 to 47 days in 2001. During this period of 

time the recidivism rate-increased by 14 percentage points for men and 3 percentage points for 

women. 

Despite the limitations of the HMlS, the Community Shelter Board has been collecting extensive 

data on its homeless service system for many years, data that have guided both program and 

policy development in Columbus. Indeed, because it has these data and CSB "knows our 

system," it is better able to evaluate the quality of the Service Point system (other communities 

may not have such an advantage). These data have been used to evaluate the costs ofrunning 

various Rebuilding Lives programs. Scattered site models are more administratively challenging 

to operate and are not as able to access Federal or state funding. Larger supportive housing 

developments that include a mix of formerly homeless and other low-income persons (lowincome working people, students, retirees, etc.) appear to be the most cost effective, and are also 

more stable and more acceptable to the community. 16 

The cost benefits result from economies of scale, as well as the ability to leverage substantial 

Federal, state, and private investments in larger housing developments. Scattered site 

developments are funded exclusively by local dollars; they cannot take advantage of tax credits 

for developers, McKinney HOD funds, or project-based Section 8 supports. With larger projects, 

one can also achieve a better mix of clients with high and low needs. To be cost effective, one 

16 Note that when projectslbuildings house both Rebuilding Lives and other tenants, the support services are 

generally available to all of the residents of the building (engagement and use of the services, however, may be 

higher among the Rebuilding Lives tenants). 

C.18 
Appendix C: Columbus 

needs to provide just the right level of services to keep clients stably housed. With small projects, 

clients anive and need highly_intensive services on an ongoing basis. Over time, however, their 

needs diminish and yet the high intensity services are still there. With larger projects, there is a 

better mix of high- and low-need clients and the support services that are available are used more 

efficiently. However, a project can also be too large, both absolutely and with respect to its 

community. The basic efficiency issue in Columbus, other than accessing funding sources for 

housing, is the efficiency with which supportive services staff can be used. 

The Community Shelter Board is just beginning to encourage individual Rebuilding Lives 

projects to make their costs more consistent (and consistently low). Also, CSB no longer pays for 

some types of services, such as alcohol and drug treatment, physical health, and employment 

services (these are still available to residents but must be covered through mainstream sources). 

CSB is working on securing the funds to bring in an outside evaluator to examine the Rebuilding 

Lives initiative and document its impact on whole community, including changes in the shelter 

system (which was one of the goals of the initiative). 

Public Funding 

A major focus of the original plan is identifying and securing the resources needed for 

implementation. The plan outlines several options for new financial resources: establishing 

dedicated local revenue sources for broad-based affordable housing activities; encouraging 

innovative, entrepreneurial businesses tied to programs serving homeless individuals; and 

generating private, state and Federal funding for specific projects. 

Resources for Rebuilding Lives are managed through a specially created "Funder Collaborative." 

Through the-collaborative, individual funding agencies pool their resources to achieve mutually 

agreed-upon goals, establish common expectations about what outcomes are to be achieved, and 

specify what reporting requirements are needed to document progress towards those goals. In 

addition to the Community Shelter Board (which oversees the implementation of Rebuilding 

Lives, chairs the Funder Collaborative, and serves as the main fiscal agent for the initiative), 

many different types of agencies and organizations are on the Funder Collaborative: 

• Alcohol, Drug and Mental Health Board, David Royer 

• City of Columbus Administration, Trudy Bartley 

• Columbus City Council, Chari eta B. Tavares 

• Columbus Foundation, Emily Savors 

• Columbus Health Department, Tom Horan 

• Columbus Mayor's Office, Erika Clark Ingram 

• Columbus Medical Association Foundation, Phil Cass 

• Columbus Metropolitan Housing Authority, Dennis Guest 

C.19 
Appendix C: Columbus 

• Corporation for Supportive Housing, SaUy Luken 

• Franklin County Department ofJob & Family Services, Mary Lou Langenbop 

• Franklin County Mental Retardation !Development Disabilities (MRlDD), Jed Morrison 

• Franklin County Administration, Anthony Forte 

• Franklin County Office on Aging, Antonia Carroll 

• Mid-Ohio Regional Planning Commission, Kathy Werkmeister 

• Ohio Capital Corporation for Housing, Hal Keller 

• United Way of Central Ohio, Janet Jackson 

• Veterans Service Commission, David Bradley 

• Chairperson, Barbara Poppe, Community Shelter Board 

Members include representatives of city and county government, all of the major public 

agencies, including many mainstream agencies such as the Metropolitan Housing Authority and 

the Departments of Job & Family Services and Health, other private agencies such as the 

Corporation for Supportive Housing, and philanthropic organizations such as the United Way. A 

key member of the collaborative is ADAMH (the Alcohol, Drug and Mental Health Board of 

Franklin County), which coordinates all community-based alcohol, drug addiction, and mental 

health services in Columbus. ADAMH does not provide any direct services, but contracts with a 

network of 45 public and private health care agencies to treat people in need. The Board meets 

quarterly and its primary responsibilities are to serve as the mental health, alcohol, and drug 

addiction planning agency for Franklin County; assess community needs, establish priorities, and 

develop a system of care to meet these needs; monitor and evaluate services for quality, 

accessibility, availability, effectiveness, and fiscal accountability; and advocate for and develop 

local fmancial support for mental health, alcohol, and drug addiction programs. 17 Since 

Rebuilding Lives was launched, the Funder Collaborative has met monthly and now meets every 

other month to address funding and system issues-it is the main mechanism for coordinating 

and monitoring the system. 

17 Almost half of the ADAMH system's resources are drawn from a single property tax levy (approved by voters), 

and the remainder comes from state, Federal, and private sources. 

C.20 
Appendix C: Columbus 

Table C.6: Local Agency Investments In Ending Street Homelessness 

C.21 
Appendix C: Columbus 

The Community Shelter Board funds individual projects with money from a variety of sources 

including city/county general-funds, the United Way, and philanthropic donors. Projects also 

receive direct funding through HUD's Continuum of Care program, a small share of state dollars, 

and other funds. For the current year, the Rebuilding Lives budget is $5 million: this includes 

some resources for shelter reconfiguration but most of it is for permanent supportive housing. 

Figure C.l shows the sources of funds for Rebuilding Lives for 2003 (it does not reflect any 

Medicaid funds, however) and it includes funds that CSB does not directly administer (i.e., funds 

that go directly to Rebuilding Lives programs and service providers). Major funders are the 

Franklin County Board of Commissioners, the City ofCoiumbus, and the United Way of Central 

Ohio. The 17 percent of funds from CSB reflects the portion ofCSB's funds dedicated to 

Rebuilding Lives including long-standing shelter services funds (CSB's traditional funders 

include the city, county, United Way, and philanthropic donations). 

Chart C.l 

Summary of 2003 Revenue Sources for 

Operations and Services Costs of Rebuilding Lives 

United Way Other 

Tenant Rent 4% 0% ADAMH 

6% 

Sponsor Generated Funds 

6% 

State of Ohio City of Columbus 

1% 9% 

HUDSHP 

13% 

CMHA 

17% 

4% CSB 

17% 

Faced with a shortfall in its budget for the upcoming year, the Community Shelter Board did not 

anticipate being able to adequately fund its current shelter and housing services for FY 2003. 

After consulting with various stakeholders, the Board of Trustees decided to maintain its funding 

emphasis on shelters and supportive housing; and if needed, reduce funding for supportive 

services in shelters and outreach, homeless prevention, and direct client assistance. Of its $5.5 

C.22 
Appendix C: Columbus 

million for program support, 57 percent will go to emergency shelters, 27 percent to supportive 

housing, 7 percent to prevention, and 8 percent to housing services (Community Shelter Board, 

2003). 

The Community Shelter Board does not fund capital grants but it does help agencies secure such 

grants. Now that it has a better sense of the actual costs, it is better able to predict the flllancial 

needs ofa project (and operational and service costs have to be renewable). The costs are about 

$14,000 per unit per year for operations (mostly rent) and services. 

HUD dollars are the only Federal dollars the Community Shelter Board uses to support 

Rebuilding Lives and there are no real restrictions on them: "they are flexible and we can use 

them well." There are some challenges associated with Federai guidelines (passed within the last 

several years) such as tenants not having any prior felony convictions; CSB is still working on 

resolving these kinds of barriers to housing. 

Community Relations and Advocacy 

Any successful permanent supportive housing effort must effectively balance the needs and 

concerns of shelter residents, service providers, and funders with those of the neighborhood and 

larger community where the housing is located. As part of the Rebuilding Lives initiative, 

Columbus convened a broadly representative Community Advisory Committee to seek the 

community's input and address any concerns. Community relations are addressed in multiple 

ways: (l) The Community Shelter Board has a rigorous shelter certification process to ensure 

that shelter programs meet high quality and accountability standards; (2) a Citizens Advisory 

Council monitors and evaluates services and programming within Rebuilding Lives programs; 

and (3) CSB works with all supportive housing and shelter operators to help them implement 

"Good Neighbor Agreements." The purposes of the Good Neighbor agreements are several: 

• 	 To promote communications, respect, and trust among neighbors, residents of the 

permanent supportive housing, service providers, and funders by assuring that the rights 

and responsibilities of all parties are understood and monitored; 

• 	 To assure that safety, security, codes of conduct, and property standards are established 

and upheld; 

• 	 To establish successful, long-term relationships while providing all stakeholdersneighbors, neighborhood organizations and agencies, neighborhood businesses, and other 

community-based groups-with the opportunity to be involved in planning, decisionmaking, monitoring, evaluating and re-negotiating the agreements; and 

• 	 To provide a structure and process for resolving conflicts and minimize litigation. 18 

18 Good Neighbor Agreements do not include matters that are governed by law, such as fair housing laws and 

municipal codes. See Community Shelter Board, Community Advisory Committee, "Good Neighbor and Shelter 

Certification," DRAFT for Public Comment, Columbus, Ohio, November 30,1999. Accessed on-line at 

http://www.csb.org/Publications/gnsc.pdf 

C.23 
Appendix C: Columbus 

The Community Advisory Committee has helped develop standards for the agreements, but each 

agreement is unique. Good Neighbor Agreements can cover many types of issues including those 

listed below. 

Elements ofGood Neighbor Agreements 

• Property 

>­ Neighborhood property: maintenance and appearance standards (landscapes, trash 

and litter) 

>­ Design Input 

• Neighborhood Codes of Conduct 

>­ Agency's responsibilities for informing all residents of neighborhood codes of 

conduct. All neighbors and residents uphold mutual behavior expectations such as 

neighborhood's codes of conduct. 

• Community Safety 

>­ Community policing and crime prevention 

>­ Block watches 

>­ Security lighting 

• Communication and Information 

>­ Marketing 

>­

>­

Disclosure of infonnation about provider's other facilities; communications about 

property concerns 

Process for continued communications among parties 

>­ Participation in facility and neighborhood committees and boards 

>­ Mechanisms for sharing information and resources 

>­ Mechanism for informed planning and decision-making that is inclusive 

>­ Responsibility for management of media relations 

• Agreement Monitoring and Compliance 

>­ Compliance mechanisms 

C.24 
Appendix C: Columbus 

» Responding to non-compliance 

» Implementation of agreement provisions by the parties 

» Enforcement of Federal laws, local codes, and state regulations 

» Dispute resolution mechanisms 

» Fair eviction procedures 

» Re-affuming and re-negotiating agreements 

The success Columbus has achieved in securing widespread community involvement in the 

Rebuilding Lives initiative is reflected in the number and breadth of agencies involved in the 

Rebuilding Lives Funder Collaborative, as well as the public's widespread support of the 

initiative. A 1999 winter newsletter published by the Coalition on Homelessness and Housing in 

Ohio (COHHIO) reported that "The public ... strongly endorses a fundamental shift in overall 

policy, going from large emergency shelters to smaller, scattered site, permanent housing that 

includes job training and supportive services. In excess of 70 percent of the respondents felt that 

this strategy was an effective means of reducing homelessness" (The Coalition for Homelessness 

and Housing in Ohio, 1999). 

Our site visit also revealed that there can be "community relations" issues within the service 

provider community itself. In addition to overcoming provider resistance to new theories and 

models of service (such as "harm reduction" and "housing first"), a number of frontline workers 

raised the issues of race and gender. Rebuilding Lives was originally intended to serve men only. 

About a year ago, the community decided to make the initiative gender neutral, both to address 

concerns about gender equity but also to resolve a variety a problems that arose around Fair 

Housing Laws. With its focus on chronically homeless people, Rebuilding Lives still serves 

mostly men (about 90 percent). 

In addition to gender (one frontline worker commented that the system "penalizes women for 

accessing shelters"), several people mentioned concerns around race. A number of frontline 

workers pointed out the difference in the racial profile of those on the streets (or "-on the land") 

and those who are getting into housing-some of this may be a reaction to the "old" supported 

housing, which still exists, and that has high eligibility standards related to sobriety and criminal 

histories that effectively screens out many African American people. Much of this housing was 

and is supported through Shelter Plus Care. The street and shelter population, by contrast, is 

predominantly (60 to 80 percent) African American. One observer noted that there are "only a 

few African American people with control over the rules and regulations," and "when a few 

people control who's going to get the housing, African Americans and women are not going to 

get the housing." Several frontline workers also noted that the mental health system does not 

serve people of color well (in one case voicing a perception that large African American men 

tended to be medicated and sedated more often or more heavily because of fear on the part of 

healthcare workers). Some providers tried to develop an African American committee within the 

homeless coalition to address equity issues around access to housing, but it was not well 

received. They would also like to see more African American housing developers become 

C.25 
Appendix C: Colwnbus 

involved in producing permanent supportive housing. Other communities would do well to be 

aware of the importance of race should they adopt similar initiatives, and to track the racial 

composition of those entering permanent supportive housing as compared to those who are on 

the streets or in shelter. 

The Future--Maintaining and Enhancing the System 

The key to maintaining and enhancing the Rebuilding Lives initiative is ensuring that the funds 

needed to maintain all existing units of supportive housing are there, and that additional funds for 

the new units needed to reach the communities goals of 800 units are also secured. In late 2002, 

the Community Shelter Board developed detailed estimates of both of these costs as well as 

funding gaps (see Table C.7) (Community Shelter Board, 2003). They also revised the time line 

to reflect the poor economic conditions the community is facing. 

Table C.7 


Summary of Operations & Services for Projects Currently Operating or Funded 


(372-412 Un its) 


. , , " ; . . ',. ,I. I _. 

2002 $6,339,327 $6,356,571 $17,244 

2003 $7,003,454 $7,003,454 $0 

2004 $6,762,513 $6,570,787 ($191,727) 

2005 $6,929,682 $6,683,037 ($246,645) 

2006 $7,101,868 $6,798,656 ($303,212) 

2007 $7,288,993 $6,927,519 ($361,474) 

These estimates are for operations (mostly rent) and services. Although they not directly 

supported by the Community Shelter Board or the Funder Collaborative, capital funds are also 

needed to develop the new units of housing. A more recent estimate by the Shelter Board puts 

this figure at just over $40 million (the higher figure of388 additional units reflects a slight 

shortfall in new units in 2002 due to poor economic conditions) (Community Shelter Board, 

2003). 

Obviously, the community will need the ongoing support of its major funders, including the 

Franklin County Board of Commissioners, the City of Columbus, and the United Way of Central 

Ohio. City and county budgets, however, are developed annually and while it would be nice to 

have ongoing commitment from these sources, this is unlikely. In addition, some of initiative's 

initial investments were made in order to establish (and demonstrate to others) that permanent 

supportive housing works and is cost effective. Now that that these goals have been met, it is not 

clear if these investors can/will continue supporting the initiative at the same levels. 

C.26 
Appendix C: Columbus 

Table C.B 


Total Estimated Funding Needs for Additional Rebuilding Lives Units 


, , ~ 

I ~ 

"1­ I I, - -: 'I' ~ \- - 'I -­

- I 

158 Rehab $15,010,000 $923,352 $1,343,000 

230 New Construction $25,300,000 $1,344,120 $1,955,000 

388 Total $40,310,000 $2,267,472 $3,298,000 

Note: Estimates are based on the following assumptions: Rehab costs $95,000 per unit, new construction 

costs $110,000 per unit, and annual operations cost $5,844 per unit ($487 is the Fair Market Rate for an 

efficiency unit). Services are estimated at $7,300 per unit (the median cost for currently operating units). 

The community has identified a number of strategies that may help them as they move forward 

with the initiative. These include (Community Shelter Board, 2003): 

Resource Development 

The Rebuilding Lives Funder Collaborative will coordinate and guide sponsors' efforts to 

identify and submit competitive applications for state and Federal funding. 

Sponsors will be expected to assist eligible tenants with accessing all appropriate entitlements 

and mainstream services. 

The Community Shelter Board and the Corporation for Supportive Housing, along with 

appropriate Rebuilding Lives Funder Collaborative members, will work with state and Federal 

officials to identify opportunities for accessing under-utilized funding sources and crafting pilot 

programs aimed at increasing the availability of funding. 

The Community Shelter Board, the Corporation for Supportive Housing, and appropriate 

Rebuilding Lives Funder Collaborative members will recruit representatives from relevant state 

agencies/departments to participate in Rebuilding Lives Funder Collaborative-sponsored 

projects. 

Improving Cost Efficiency 

The Community Shelter Board and the Corporation for Supportive Housing, along with 

appropriate Rebuilding Lives Funder Collaborative members, will provide technical assistance to 

project sponsors to operate more efficiently and effectively, and to access a greater number of 

mainstream services and funding sources. 

The Rebuilding Lives Funder Collaborative will determine ways to streamline funding processes 

and reduce administrative costs, while still remaining accountable to investors. 

C.27 
Appendix C: Columbus 

Collaborative Investment Standards 

Sponsors will access state, Federal, and other resources for capital development, operating 

subsidies, and service funding. 

The Rebuilding Lives Funder Collaborative and sponsors will use the city, county, and United 

Way funds to leverage policy reforms at the state and Federal levels and advance pilot programs. 

The development, operating, and service budgets along with the proposed service plan for all 

projects will be reviewed and approved by the Rebuilding Lives Funder Collaborative prior to 

any commitment of funds (conditional or [mal) by any RebuildingLives Funder Collaborative 

member. 

The Rebuilding Lives Funder Collaborative will establish per unit limits on capital contributions 

by the city and county. 

Generally, Community Shelter Board-administered funds from the city, county and United Way 

will not provide operating support for supportive housing. 

Community Shelter Board-administered funds from the city, county and United Way will be 

used to provide services support for supportive housing. Rebuilding Lives Funder Collaborative 

will establish limits on Community Shelter Board-administered service support (per unit and 

percentage). 

Evaluation 

The Rebuilding Lives Funder Collaborative will complete an overall evaluation of the initiative 

by the end of 2004. 

The Community Shelter Board will continue to conduct annual program evaluations. 

Communication 

Primary local funders will meet in the spring of 2005 to assess progress and adopt a plan for 

advancing the Rebuilding Lives initiative in 2006 and beyond. 

The Community Shelter Board will routinely distribute the annual report card and program 

evaluation reports to keep all key parties informed. 

C.28 
Appendix C: Columbus 

Columbus Site Visit Participants 

- - , 'I n ..~!· \ '- -;! " ­ -

James Alexander Maryhaven - Community Engagement Center 

Chyna Dickerson Maryhaven 

Jim Downing YMCA/Sunshine Terrace 

Rick Ellere YMCA 

Rachel Ginsberg YWCA 

John Hahn Columbus Metropolitan Housing Authority 

John Hardiman Community Shelter Board 

Art Helldoerfer YMCA of Central Ohio 

Nina Lewis Columbus Health Department 

Jerry Pierce 

Barbara Poppe Community Shelter Board 

Eric Preuss Faith Mission/Faith Housing 

Amy Price Southeast, Inc 

Grant Schroeder Maryhaven 

Kathryn Spergel Friends of the Homeless, Inc. 

Cheryl Tucker CSB-Data 

Annabelle Van Meeter Columbus Neighborhood Health Center 

Susan Weaver Community Housing Network 

Tony Williams Faith Mission 

C.29 
ADAMH 

B.R.E.A.D 

CMHA 

COHHJO 

CSB 

FCDJFS 

HTF 

MORPC 

MRJDD 

ODRC 

SRO 

TANF 

UWCO 

Appendix C: Columbus 

Columbus Acronyms 

Alcohol, Drug and Mental Health Board 

Building ResponsibiIity, Equality, And Dignity 

Columbus Metropolitan Housing Authority 

Coalition on Homelessness and Housing in Ohio 

Community Shelter Board 

Franklin County Department of Jobs & Family Services 

Housing Trust Fund 

Mid-Ohio Regional Planning Commission 

Mental Retardation !Development Disabilities 

Ohio Department of Rehabilitation and Corrections 

Single Room Occupancy 

Temporary Assistance for Needy Families 

United Way Columbus 

C.30 
APPENDIX D: LOS ANGELES 


Los Angeles-Brief Description 

In 2002, the City of Los Angeles had a population of 3.8 million, making it the largest city in Los 

Angeles County, which had a population 9.9 million. Los Angeles City's unemployment rate was 

10.8 compared to the nation's 5.8 and Los Angeles City's poverty rate for single individuals was 

18.2 compared to the nation's 16.3 percent. 19 Exacerbating the combined effects of poverty and 

unemployment is the high cost of housing. An individual needs to earn close to $23,000 per year 

to afford an efficiency apartment in Los Angeles?O To put it in more concrete tenns, a person 

earning minimum wage in Los Angeles needs to work 70 hours per week to afford an efficiency 

apartment. Overall, the consumer price index for Los Angeles is 35 percent higher than for the 

rest of the nation? I 

The Los Angeles Homeless Services Authority (LAHSA), which provides funding and guidance 

for local nonprofit agencies with programs that address homelessness, coordinates the Los 

Angeles Continuum of Care (CoC) proposals. Beyond LAHSA, Los Angeles does not offer a 

single coordinated system for reducing chronic street homelessness and we therefore do not 

describe the history or other community-wide activities as we do for the other cities included in 

this report. What Los Angeles does offer, because of its immense size, is several specialized 

continuums to meet the needs of homeless individuals. Described in this chapter are three 

organizations that have been working diligently to end chronic street homelessness. They are the 

Department of Veterans Affairs (VA) Healthcare for Homeless Veterans Programs, Lamp 

Community, and the Assembly Bill (AB) 2034 program administered by the Los Angeles County 

Department of Mental Health (LAC-DMH) Adult Systems of Care. The Department of Veterans 

Affairs and Lamp Community both offer a comprehensive array of services for homeless 

individuals, while the AB 2034 Program provides funding for mental health services, including 

housing and personal and incidental needs. Although these programs do not all work in concert 

with each other, there is significant overlap among the systems. For example, Lamp Community 

is one of the 16 AB 2034 providers in Los Angeles County, and at least one VA partner agency 

collaborates with Lamp Community to provide housing for Lamp members. Another 

organization, Shelter Partnership, collaborates with both the AB 2034 Program and Lamp 

Community by providing technical assistance in many areas including housing development, 

funding, and grant writing. Shelter Partnership also touches many agencies through its advocacy 

for homeless individuals and its shelter resource bank, which provides surplus merchandise to 

homeless agencies. 

During our site visit to Los Angeles from April 28 - May 1, 2003 we visited each of the three 

organizations and selected partner agencies, and interviewed 54 individuals representing 

administration and management, as well as case workers, outreach workers, and housing 

specialists. A complete list of persons interviewed during the site visit is available at the end of 

this appendix. During the site visit, we also toured several agencies and conducted two focus 

19 U.S. Bureau of the Census, http://ferret.bls.census.gov/cgi-binlferret . 

20 National Low Income Housing Corporation, http://www.nJihc.org. 

21 The Cost of Living Index for Selected U.S. Cities, http://www.infoplease.com. 

D.l 
Appendix D: Los Angeles 

groups of formerly homeless individuals who have been stably housed for at least six months. In 

writing this chapter, we used information from site visits, telephone interviews, written reports 

provided by the agencies, agency websites, and the Continuum of Care narrative. 

Greater Los Angeles Department of Veterans Affairs 

There are more homeless veterans in the Los Angefes County area than in any other county in 

the United States. Likewise, the VA Greater Los Angeles Healthcare System is the largest VA in 

the system. VAGLAHS has three sites: the LA campus (including the West LA Healthcare 

Center), the Sepulveda Ambulatory Care Center located in the San Fernando Valley, and the Los 

Angeles Ambulatory Care Center located in downtown Los Angeles. V AGLAHS treats over 

6,000 homeless veterans each year, w bich represents about 10 percent of all homeless veterans 

served by the Health Care for Homeless Veterans Programs in the country. 

Practices of Potential Interest to Other Jurisdictions 

Each of the Los Angeles county programs offers practices of potential interest to other 

jurisdictions. 

VA 	Greater Los Angeles Healthcare System (VAGLAHS) 

• 	 Federal agency/ local provider partnership networks. The V AGLAHS and its partners 

combine local VA funds with Federal Grant & Per Diem funds to create a collaborative 

network of agencies to provide a continuum of care. The V AGLAHS values the network 

to the point that if they no longer received Grant & Per Diem money, staff members 

believe they would find the funding for homeless programs and the network in the local 

budget. (Contact person: William Daniels, Director of Conference of Homeless Program 

and the vision homeless coordinator, William.daniels@med.va.gov, 310.268.3348.) 

• 	 The Access Center. Co-locates medical care, mental health assessment and treatment, 

and homeless services to address the many needs of homeless veterans immediately upon 

their fIrst visit to the center. (Contact person: Mariquita McBride, Associate Leader of the 

Northside Care Center, Mariquita.mcbride@med.va.gov, 310.268.3348.) 

Los Angeles County Department ofMental Health AB 2034 Program (AB 2034) 

• 	 Flexible funding used to leverage services. The San Fernando Valley AB 2034 program 

agency uses its DMH funding to leverage a variety of special services for clients, creating 

a comprehensive program that is able to meet all the needs of its clients. (Contact person: 

Bonnie Roth, Assistant Director of homeless services LCSW email: broth@sfvcmb.org, 

818.901.4836. ) 

• 	 Non-capitated and flexible funding. Provides the latitude to secure the most intense 

services where and when they are needed. Clients require less funding as they become 

D.2 
Appendix D: Los Angeles 

stabilized. (Contact person: Maria Funk, Mental Health District Chief, email: 

MFunk@dmb.co.la.ca.us, 2l3.738.4385.) 

• 	 Housing Specialists. Housing Specialists provide technical assistance and temporary 

flllancial relief for Section 8 landlords serving their clients, so that AB 2034 clients can 

resolve problems between tenants and landlords. Housing Specialists have made such an 

impact that some landlords have taken their names off the BUD Section 8 list and only 

rent to AB 2034 clients or lease to AB 2034 agencies. Some landlords are developing 

new property exclusively for AB 2034 agencies and their clients. (Contact person: Reina 

Tumer, email: RTumer@dmh.co.la.ca.us. 2l3.739.6267.) 

Lamp Community 

• 	 A non-linear housing approach enabling individuals to move between housing 

programs offering more or less structure has worked for seriously mentally ill and dual 

diagnosed homeless persons who have trouble moving through a linear program of 

decreasing structure. (Contact person: Mollie Lowery, info@lampcommunity.org, 

2l3.488.9559.) 

• 	 Social capital: A life-long community rich in social capital enhances the individuals' 

sense of belonging and therefore their likelihood of remaining off the streets. (Contact 

person: Mollie Lowery: info@lampcommunity.org, 2l3.488.9559.) 

• 	 Mental health provider/property management collaboration: The key to housing 

mentally ill persons is close relations with the mental health providers and enhanced 

property management services. It is particularly important to have enhanced property 

management services during weekends when there is decreased access to mental health 

and case management services. (Contact person: Jim Bonar: info@skidrow.org, 

2l3.6l3.0522.) 

Primary Contact Persons 

Department of Veterans Affairs 

Bill Daniels 

V A West Los Angeles Medical Center 

11391 Wilshire Blvd. (10H5) 

Los Angeles, CA 90073 

Telephone: 310.268.3348 

E-mail: William.Daniels@med.va.gov 

Web Site: http://www.va.gov/homeless/ 

Los Angeles County, Department of Mental Health 

Maria Funk, Ph.D. 

Program Manager 

Adult Systems of Care 

550 S. Vermont Ave., 12th Floor 

D.3 
Appendix D: Los Angeles 

Los Angeles, CA 90020 

Telephone: 213.738.4385 

Lamp Community 

Michele Yu 

527 S. Crocker Street 

Los Angeles, CA 90013 

Telephone: 213.488.9559, ext. 46 

E-mail: info@lampcommunity.org 

Web Site: www.lampcommunity.org 

V AGLAHS History and Context-How the Current System Evolved 

During the late 1980s and early 1990s homeless service providers and advocates appealed to the 

V AGLAHS administration and demonstrated on the LA campus to obtain more services for 

homeless veterans. The group met resistance. At that point, the V AGLAHS homeless services 

were limited and the Domiciliary was the only transitional housing program available. Providers 

and advocates went to Washington, DC to inform congressional leaders about the lack of 

services for homeless veterans. This movement resulted in a congressional hearing on the 

grounds of the LA campus, with testimony representatives of the V AGLAHS and community 

agencIes. 

During the same time frame, staff from a community based organization, New Directions, 

wanted to begin providing services to veterans in one of the many empty buildings on the LA 

campus, but met great resistance to this idea. The organization worked to get an act of Congress 

to acquire a building on the campus, which occurred in 198911990.22 The building is now the site 

of the New Directions South program. 

In the early 1990s the V AGLAHS began to respond to this increase in demand for homeless 

veterans services (McGuire, et aI., 2001). After the congressional hearing, a new administration 

was brought in and created a department focused on homeless services. The V AGLAHS 

leadership began to communicate with agencies about what veterans needed and how to develop 

a collaborative to address those needs. To further complicate the VAGLAHS ' s situation, the 

West LA Health Care Center was downsizing its inpatient health care services because of 

lowered resources at the same time that the V AGLAHS was trying to build the homeless service 

approach. The V AGLAHS recognized that it needed community organizations to adequately 

serve chronically homeless veterans who face many barriers to service. The VA proceeded to 

develop partnerships with community agencies from 1992 through 2000, resulting in a total of 

930 new transitional housing beds for veterans in the community-up from the six beds that 

were available in 1992 and the largest number in the country connected to a VA facility. 

22 The lease was eventually signed in 1995, until then the program provided services to veterans in houses in the 

conununity. 

0.4 
Appendix D: Los Angeles 

V AGLAHS Approach to Chronic Street Home)essness 

The VAGLAHS provides a continuum of care for homeless veterans through a collaborative 

network of agencies using resources in the Health Care for Homeless Veterans Programs 

(HCHV). The purpose of the HCHV is: (1) to provide-outreach to severely mentally ill veterans 

who are not using V A medical services; (2) to link individuals to V A clinical services, contracted 

residential treatment programs, and contracted transitional or permanent supported housing 

programs; and (3) to provide treatment and rehabilitation services (Kasprow, et aI., 2002). A 

comprehensive collaborative network has been built by combining the resources and capabilities 

of the V AGLAHS with those of other community agencies. Table D.I lists the agencies involved 

in the collaborative network and the services provided by each. The rows represent the partner 

agencies and the columns represent the types of programs and services offered. An "X" in a cell 

indicates that the provider offers that program or service. An "F" indicates that a public agency 

funds a program or service, and an "E" indicates that the provider offers expert advice, technical 

assistance, or training. 

The goal of the VAGLAHS collaborative network is to assist veterans to leave the streets and 

lead productive lives. Specifically, the network addresses four needs of homeless veterans: (1) 

access to health care and treatment; (2) income from benefits and/or employment; (3) stable 

housing; and (4) support networks. The collaborative network approach is based on the premise 

that no single agency can provide comprehensive services to meet these four needs. Therefore, 

the network includes programs that range from unstructured drop-in centers to treatment 

facilities. 

D.5 
Appendix 0: Los Angeles 

Table D.1: Department of Veterans Affairs Network of Agencies Involved in Ending Chronic Street H

§­

.::i U 

t::: II) 

1'.,§' 

::; Q; 0 

Agencies Serving Currently or 

Formerly Chronic Street 

Homelessness People (listed 

SI. Joseph's 

The Mary Lind Foundation 

New Directions, Inc. x 


Single Room Occupancy Housing 

Corporation 

People in Progress x 


U.S. Vets, Inc X 


The California Council for Veterans 


Affairs 


LA Family 


The Salvation Army x 


Volunteers of America X IX 


Weingart Association X 


Agencies Serving Currently or 

Formerly Chronic Street Homeless 

People 

Homeless Veterans Health Care F,X,E 

Housing and Urban Development 

Employment Development 

Department 

Social Security Administration 

LA County Department of Public X
 Social Services LA County Sheriffs Department LA Police Department X 


x = Provider 

Homeless-Related Programs and Services 

·ff 

.§ " ·s 

.§ " t 0 "5 t UO 'lJ '\:1 f> "5 {2 '" § JJ tS 

d- :! II) t r& 0; 'r 9J 
 O- 'j< 8' § 'lJ $ '0s: F ,f '" 0' <ti ;f £$ cJ 60' q: 

x X 


X X X X 


X 
 I I 
X X I l X X X 
X X X 
X 


X X X X X 

X X X X 
X X X X 
X 


F,E F,X,EIF,X,EIF,X,E X,E F,X,E I X,E IX,EIX.

F 

X 


X 
X 


X 


E = Expert T A Provider F = Funder 

0.6 
Appendix D: Los Angeles 

The VAGLAHS collaborative network approach addresses veterans' needs in the following 

ways: 

• 	 The VA provides health care and psychiatric and substance abuse treatment to veterans; 

• 	 Income is addressed through benefits and employment. Veterans are enrolled in V A 

benefits if eligible and if not eligible, the V AGLAHS staff members work with social 

security staff for expedited approval of social security benefits. The V AGLAHS has also 

partnered with organizations to provide job training and employment assi-stance to 

homeless veterans. Further, V AGLAHS staff members have set up a payee project with a 

local private nonprofit organization that most homeless veterans use for assistance with 

money management; 

• 	 A network of community-based programs provides housing. All the programs are 

transitional housing and work to move the veterans to housing that is more permanent or 

another program upon discharge. No homeless veterans are discharged to the street; and 

• 	 The V AGLAHS staff and each of the partner agencies work to develop new support 

networks for veterans and some agencies specifically focus on reuniting and/or 

improving veterans family relationships. 

Since 1994, the V AGLAHS has been partnering with local community agencies through Project 

Community Homelessness Assessment, Local Education, and Networking Groups (CHALENG). 

Project CHALENG annually brings together agencies that provide services to veterans to share 

information and network. Some of the Project CHALENG agencies are also part of the Grant & 

Per Diem program, a group that has a much higher level of collaboration between agencies. 23 

Each individual partner applies for Grant & Per Diem grants. The Grant & Per Diem programs 

formally meet on a quarterly basis, but individually have constant informal contact throughout 

the year with each other and the V AGLAHS staff. The V AGLAHS staff members notify partner 

agencies about funding opportunities and spend time educating other agencies about what the 

V AGLAHS offers to veterans. 

The staff set policy around quality operations for partners and provide technical assistance to 

partners to meet the quality standards. As part of a quality improvement program, V AGLAHS 

staff members developed an incident reporting system that enables the partner agencies to track 

problems associated with the care of their clients. They.also developed a discharge/service 

history database that provides the ability to track the service-use patterns of individual veterans. 

Once funded through the Grant & Per Diem system, a master's level VAGLAHS liaison assists 

the partner agency in becoming operational. The liaison conducts a full review and inspection of 

the program and its structure, including nursing, dietician, fiscal, clinical reviews. The liaison 

23 The Grant & Per Diem Program is a funding mechanism for agencies providing homeless services for veterans. 

The Grant portion provides funds for up to 65 percent of the cost of facility renovation or construction. The Per 

Diem award goes to recipients of Grants and funds operational expenses for supportive housing up to a per diem 

of$26.95 . 

D.7 
Appendix D: Los Angeles 

notifies the agency when it is ready to provide services and begin admitting veterans. Thereafter, 

liaisons perform annual safety and program inspections of each partner agency. 

Additionally, the liaison works with the partner agency day-to-day throughout the year. 

V AGLAHS liaisons advocate to the programs on behalf of the veteran to ensure the program is 

delivering the services it promised. Depending on the partner agency and the need, the liaison 

staff might be located on site, might provide integrated case management services to clients 

along with case managers from the partner agency, or might review case files. Liaisons also meet 

with the veterans as a gnmp to assess their perceptions of program operations. Finally, staff 

liaisons review veteran status in the discharge/service history database to ensure referral and 

service plans are appropriate. 

On campus, the VA provides medical services as well as psychiatric and substance abuse 

treatment and transitional housing at the Domiciliary (321 beds). In addition, a number of 

nonprofit agencies provide services on campus. New Directions has two programs on campus 

including a long-term substance abuse treatment center (156 beds) and a dual diagnosis treatment 

program (43 beds). The Salvation Army has three programs on campus including a residential 

substance abuse treatment program (Haven 1---60 beds), a recuperative care short stay facility 

(Haven II-30 beds), and a residential mental health program (Exodus-90 beds including 30 for 

extended post-inpatient psychiatric discharge planning and 60 board and care residential beds). 

Off campus, the VAGLAHS collaborates with U.S. Vets, Inc., which operates the Westside 

Residence Hall. The Hall has 450 transitional housing beds including 136 beds for a 90-day 

housing program and 314 beds for a long-term transitional supportive living program, 150 of 

which are also part of a work rehabilitation program. 

The V AGLAHS collaborative network is structured so veterans can receive individualized 

services. The nonlinear structure of services allows homeless veterans to enter any part of the 

network and move into other parts of the network as needed. The V AGLAHS and its partner 

agencies coordinate with one another to fill the beds within the collaborative network so that 

people are being served based on their need and moved through the system when appropriate. 

Staff members try to keep the network as fluid as possible so individuals can move back and 

forth in the system as their needs change. In addition, by coordinating around the beds, the 

system prevents individual veterans who may happen to learn about a particular bed opening 

from being placed in it ahead of someone else who has been waiting. 

A V AGLAHS case manager is assigned to each veteran in the system and assists the person who 

has been waiting to move from program to program as necessary. For example, the case manager 

works with veterans to develop discharge plans before they become residents of Exodus or 

Haven II because these are considered interim placements to a next step. The purpose of both 

Haven II and Exodus is to create access to the collaborative network, to prevent hospitalization, 

and to provide temporary housing while a veteran is waiting for a Domiciliary placement. If 

programs are filling or full, case managers investigate who is ready to move on to other more 

independent housing options such as the Westside Residence Hall. 

D.8 
Appendix D: Los Angeles 

VAGLAHS Selected System Components 

The V AGLAHS collaborative network has services both on the LA campus and off campus 

(McGuire, et ai., 200 I). 

Outreach and Drop-in 

Street outreach. V AGLAHS staff members conduct street outreach throughout Los Angeles 

County. Outreach workers refer homeless veterans to the downtown drop-in clinic and to the 

Access Center on the LA campus. They provide bus tokens for transportation to the campus. The 

importance of street outreach is demonstrated by a marked decrease in the number of veterans 

using the Access Center and the downtown drop-in clinic during the annual outreach training 

session when no one is on the street engaging homeless veterans. 

Outreach workers look for homeless veterans at the Department of Public Social Services, meal 

sites, food pantries, on the street, in parks, police stations, beaches, camps, and Alcoholics and 

Narcotics Anonymous meetings. The workers try to engage the veteran in conversation about 

V A benefits, enrollment status, and other issues they face. Many outreach workers are formerly 

homeless veterans themselves, and are able to engage the veteran and build trust and rapport. 

Nine staff members conduct outreach in the mornings (two V AGLAHS and seven ArueriCorps 

staff) and return to the Homeless Access Center for the afternoon to follow up with individuals. 

One worker conducts outreach in the evenings and on weekends. 

LA County Jail Outreach Program. VAGLAHS staff members (5.5 FTE) conduct outreach at 

the Twin Towers County Jail, which has a dedicated wing for veterans?4 V AGLAHS staff 

members work with inmates conducting assessments and referrals to community programs. A 

V AGLAHS social worker is on site in the Inmate Reception Center. The worker engages 

offenders who are veterans as they come into the jail system and receives a daily list of veterans 

in the jail system. A V AGLAHS counselor is assigned to each veteran within the first 48 hours to 

assess service needs. About 24 veterans enter the jail system daily on weekdays and about 75 do 

so on weekends. Not all veterans are eligible for services (veterans are not eligible if they have a 

negative discharge status from the military or they did not serve long enough). The social worker 

and counselors fmd the veterans appropriate housing, work with diagnostic issues, check their 

service use in the discharge/service history database, and consult with judges about appropriate 

placements. The counselors will create discharge plans for homeless veterans straight into 

transitional housing, Haven II, or substance abuse treatment. Counselors work with the drug 

court and other courts to have veterans diverted to programs such as Haven I, if possible. They 

also refer veterans to the VAGLAHS's downtown drop-in clinic, about a half mile from the court 

and probation offices. Judges will make reporting to the clinic a condition of probation. Upon 

release from jail, the social workers reassess the veterans for substance abuse and mental health 

treatment and homeless services. 

24 The average custody stay at the jail is 44 days. 

D.9 
Appendix D: Los Angeles 

The Community Transition Unit of the Sheriff's department works to empower inmates so they 

can succeed once they leave custody. Homeless veterans are one of the unit's target populations. 

The unit staff members contact V AGLAHS to verify veteran status of inmates before -assigning 

them to the veteran portion of the facility. Offenders can be in the veteran portion of the facility 

as long as they are not mentally ill or are not charged with murder or sex offenses. Mentally ill 

inmates are housed in a different portion of the facility. The VAGLAHS, US Vets, and the 

Salvation Army each have staff members who come into the facility to provide services and 

classes to veterans. Services include assessments for treatment, drug and rehabilitation classes, 

parenting classes, personal relationship classes, computer training, job skills, and resume 

building. 

The Access Center. The Comprehensive Homeless Access Center-the Access Center-is 

located on the LA campus. V AGLAHS staff realized that homeless veterans had multiple needs 

and designed the Access Center to co-locate primary medical care, mental health care, and 

homeless services. The access center structure dramatically changed "business as usual" for VA 

medical services. Now, a nurse conducts a complete bio-psycho-social assessment including 

medical, treatment, and housing needs. The nurse will also review the person's history of using 

V A medical and homeless services within the LA system and the larger VA network. The 

veteran receives a comprehensive treatment plan addressing all bio-psycho-social issues 

including referrals to appropriate services. Referrals to services are then prioritized according to 

need. 

Access Center clients receive same day appointments and immediate medications, which is very 

important to homeless individuals who may have difficulty keeping appointments. Homeless 

veterans can receive emergent, urgent, or routine medical care (such as physicals) the same day 

they visit the center. Those needing emergent or urgent care are transferred to the VAGLAHS 

West LA Medical Center on campus and those needing routine care are sent to the primary care 

facilities on the second floor of the building. The veterans shower and receive clean clothes 

before receiving medical care. Homeless veterans now have physicals the same day they come 

into the center as opposed to waiting six to eight weeks for a physical as they did before the 

center opened. They are also assigned a primary care provider to assure continuity of care and 

improve patient adherence with medical care. The primary care provider will provide acute and 

chronic disease state management as well as health prevention and promotion activities including 

Tuberculosis screening, HIV testing, vaccinations, cancer screenings, individualized patient 

education, and referrals to specialty care. Appointment scheduling is flexible allowing for same 

day walk-ins as well as scheduled follow-up appointments. 

V AGLAHS staff members realize housing increases stability and stability increases the 

likelihood that veterans will follow up with additional medical services and appointments. 

Therefore, in addition to immediate medical care, homeless veterans accessing the center are 

linked directly to housing. Staff members find homeless veterans temporary housing in Haven II 

or other transitional programs that have openings and are appropriate to the needs of the 

particular veteran. 

Veterans experiencing severe psychiatric problems such as delusions or suicidal ideations are 

sent to the psychiatric emergency room. Otherwise, psychiatrists conduct same day assessments 

for those experiencing less emergent psychiatric problems. The clients are then referred to the 

D.1O 
Appendix D: Los Angeles 

mental health clinic's weekJy orientation program. Access Center staff members work with the 

Psychiatry Department to increase the frequency of orientations to serve the needs of homeless 

veterans in a timelier manner because homeless veterans may not reconnect with the mental 

health clinic once they leave the Access Center. Twenty-four clinicians in the VAGLAHS mental 

health clinic have a total caseload of about 2,400 outpatient clients enrolled in the clinic at one 

time. 

After the triage process described above, about 80 percent of the clients are referred to a social 

worker for more detailed assessments of complex issues. Together the veteran and social worker 

develop referral plans to address other needs, such as substance abuse treatment and social 

service needs. The social worker continues to provide case management and follow-up services 

with Access Center clients as long as necessary. The Access Center also provides the first time 

user with a hot lunch from the campus cafeteria. The Access Center plans to begin providing 

dental care to homeless veterans in the near future. 

Access Center staffIng includes a reception worker, a social worker, triage nurses, a patient 

relations assistant (a formerly homeless veteran who helps clients move through the triage 

system), a social service technician, an eligibility clerk, a veterans benefits counselor, and an oncall psychiatrist. The Access Center staff members not only have co-located offices but also 

integrate their services so that the medical, mental health, and homeless services are seamless 

(Each patient has an integrated treatment plan assessable through the computerized record). Staff 

members conduct case conferences to integrate their service approaches for individual veterans. 

Staff members also receive integrated in-service training. 

When the Access Center first opened, the Primary Care staff members were not prepared to, and 

were somewhat reluctant to, work with the homeless population. Homeless veterans noticed the 

negative attitude of the staff members and stopped using the center. The administration then 

changed the Primary Care staffmg approach and specifically brought in staff members who were 

interested and willing to work with the homeless population. As a result, more veterans are using 

the center again. 

A number of Access Center staff members are formerly homeless veterans. These staff members 

report they feel they can connect with the homeless veterans and are able to assist them more 

effectively than other staff. They are able to read the person's s'urvival behaviors and can help 

someone "tone it down" if the veteran is getting out of control. They focus on helping currently 

homeless veterans receive the same services that helped them. 

Emergency Shelters 

LA Family Housing operates a cold/wet weather emergency homeless shelter on the LA campus 

that was closed for the season during the site visit. Use of this shelter is not restricted to veterans. 

Services include food services, showers, case management, referrals, and a full range of 

supportive services. 

D.ll 
Appendix D: Los Angeles 

Transitional Programs 

The VAGLAHS collaborative network has a number of transitional housing and treatment 

programs for homeless clients (see Table D.2). The programs use different models of care but are 

all drug and alcohol free (abstinence is required). 

The VAGLAHS Domiciliary. The Domiciliary is a 90-day rehabilitation program involving 

individualized treatment plans across five teams: medical, psychiatric, social work, vocational, 

and substance abuse treatment. Residents are involved in classes and community meetings as 

well as meeting the requirements of their individual plans. Residents spend their therapeutic day 

in VA services such as outpatient substance abuse treatment and vocational programs. In 

addition, some beds at the Westside Residence Hall are designated for people leaving the 

Domiciliary to continue their treatment. They transition into Westside for an additional 90 days 

for a total of 180 treatment days. 

Salvation Army Programs. Haven I is a 90-day residential treatment program for veterans with 

substance abuse problems and Exodus is both a 30-day transitional psychiatric treatment 

program and a long-term residential living program for severely mentally ill veterans. Program 

staff members work with the VA liaisons on housing options when people are ready to move on 

to other programs or housing. Some beds at the Westside Residence Hall are reserved 

specifically for people leaving Haven I treatment, to provide a total of 180 days of treatment. 

Haven II is short-term transitional "hop tel" housing where patients being released from medical 

services or substance abuse treatment can receive recuperative care for up to a week while they 

wait for either transitional or permanent housing placement. The priorities for referrals are 

discharged patients, those at risk for hospitalization, or those waiting for Haven I beds. Other 

priority residents include individuals waiting to be placed in substance abuse treatment programs 

or working with social workers to fmd appropriate housing. 

0 .12 
Appendix D: Los Angeles 

Table D.2 

Project: 321 bed, 90­

day transitional 

housing program on 

the LA campus 

Residents: Homeless 

veterans with sobriety 

Project: 60-bed, 90-day 

alcohol & substance 

abuse residential 

treatment program on 

the LA campus 

Residents: Homeless 

veterans with alcohol 

& substance abuse 

problems 

Project: 30-bed, 1 to 7 

day hospital-hotel 

(hoptel) lodging on 

grounds ofWLAHC 

Residents: Patients 

discharged from 

inpatient ward or unit; 

ambulatory surgery 

patients; and homeless 

and housed patients 

living far from 

WLAHC 

Social Rehabilitation 

Model 

1) Medical services 

2) Psychiatric 

s-ervlces 

3) Substance abuse 

treatment 

4) Social work 

servIces 

5) Vocational 

servIces 

Social Rehabilitation 

Model 

1) 12-step 

recovery 

program 

2) 	 Short and 

long-term 

housing 

placements/ 

discharge 

Recuperative care 

model 

1) Recuperative 

care 

2) 	 Short and 

long-term 

housing 

placement/dis 

charge 

planning 

3) 	 Lodging 

VAGLAHS: Property 

manager and primary 

service provider 

Salvation Army: 

Property manager and 

primary service provider 

VAGLAHS: Landlord 

& secondary service 

provider. 

Salvation Army: 

Property manager and 

primary service provider 

VAGLAHS: Landlord 

& secondary service 

provider. 

0 .13 
Appendix D: Los Angeles 

Table 02 (Cont.) 

Project: 30-day 

transitional psychiatric 

treatment (90-bed) and 

long-term residential 

living program (60­

bed) program located 

on the LA campus 

Residents: Seriously 

mentally ill veterans 

Project: 156-bed, longterm residential 

treatment program with 

short-term 

detoxification, on the 

LA campus 

Residents: Veterans 

with substance abuse 

problems & forensic 

Project: 43-bed dual 

diagnosis program 

typical stay is about 1 

Residents: Veterans 

diagnosed with 

substance abuse and 

mental health disorders 

Psychiatric 

recuperative care & 

board and care 

models 

1) 	 Short-term 


psychiatric 


treatment 


2) 	 Long-term 

supportive living 

environment 

Therapeutic 

community model 

1) Substance abuse 

rehabilitation 

2) 	 Long-term 


housing 


placement! 


discharge 


planning 


Therapeutic 

Community 

1) Medication 

Management 


2) Job training 


3) Money 


Management 


4) Theater work 


5) Computer 


Training 

manager, service 

provider, and property 

manager 

V AGLAHS: Landlord 

New Directions: Project 

manager and service 

provider 

VAGLAHS: Landlord 

New Directions: Project 

manager and service 

provider 

V AGLAHS: Landlord 

D.l4 
Appendix D: Los Angeles 

Table D2 (Cont.) 

Project: 136-bed, 90­

day housing program 

& 314 -bed long-term 

transitional supportive 

living program located 

in community (150 

beds are a work 

rehabilitation program) 

Residents: Homeless 

veterans with 90 days 

sobriety 

Project: Housing 

voucher & case 

management program 

Residents: Homeless 

veterans 

Therapeutic 

community & 

vocational 

rehabilitation models 

1) Transitional 

housing 

with 

Vocational 

Rehabilitation 

services 

2) Long-term 

transitional 

housing with 

some VA 

clinical 

servIces 

on-site 

Referral-case 

management model 

1) Housing 

vouchers 

2) 	 Long-term 

case 

management 

Inc. : Developer, 

landlord, and property 

manager 

LA VETS. (US VETS): 

Primary service provider 

VAGLAHS: Secondary 

service provider 

HUD: Housing voucher 

service provider 

V AGLAHS: Project 

manager, case 

management service 

provider 

Sources: Interviews and McGuire, J., Berman, S., Daniels, W. , Tran, A.N., and Mares, A. (2001). 

Creating VA-Community Partnerships for Housing Homeless Veterans: The VA West Los Angeles 

Healthcare Center Experience. Los Angeles, CA: Mental Illness Research, Education, & Clinical 

Center, West Los Angeles VA Healthcare Center, VA Greater Los Angeles Healthcare System. 

Volunteers of America. The Volunteers of America program has a number of services for 

homeless veterans. It operates a residential substance abuse treatment program in Hollywood 

with 15 beds paid for by the VAGLAHS to serve veterans. The program has 80 beds of 

transitional housing in Skid Row to assist veterans in the transition from treatment to housing. It 

also operates the Department of Labor's Homeless Veterans Reintegration Program, working 

with veterans in transitional housing to fmd employment and permanent housing opportunities. 

D.lS 
Appendix D: Los Angeles 

Further, Volunteers of America operates a drop-in center in Skid Row, where about 12 percent of 

the clients are veterans. The Veteran Service Center is part of the drop-in center and is a place 

where veterans can meet with their case managers daily. Finally, the program works with the 

Sheriffs Department to assist chronically ill homeless veterans in the Community Transitions 

Unit. 

New Directions. New Directions works with chronically mentally ill and chemically dependent 

homeless veterans through two programs housed on the VA West Los Angeles campus. New 

Directions Regional Opportunity Center is a 156-bed substance abuse treatment facility and New 

Directions North is a 43-bed program for veterans dually diagnosed with substance abuse and 

mental illnesses. New Directions staff members provide the case management and substance 

abuse treatment services. V AGLAHS staff members provide psychiatric and medical care. 

New Directions North devotes 24 beds to a social (as opposed to medical) detoxification facility. 

Clients detoxify from most types of substances for 7 to 10 days. Methadone detox, however, is 

21 days. The program treats 700 people a year, of whom about 250 enter into the full New 

Directions Regional Opportunity Center program. 

The program has 68 phase one beds. Phase one consists of six months of comprehensive 

substance abuse treatment and intensive case management, daily schooling, and educational 

assessments. Phase two has 64 beds, of which 24 are Shelter Plus Care. Phase two includes 

vocational training (such as culinary arts training, handy worker, computer, and maintenance 

training),25 transition to employment skills, life skills, case management, and permanent housing 

assistance?6 New Directions oversees the job development and job placement services and 

operates four soci.al enterprise businesses where clients can gain employment experience: 

catering, the Veterans' Village Diner (on the LA campus), construction, and retail on E-Bay. 

Phase two can last up to 18 months but the average stay is about one year. 

Westside Residence Hall. Westside Residence Hall is a 2-year transitional housing program 

with a full range of services including case management, vocational rehabilitation, medical and 

psychiatric care, and addiction counseling provided by both US Vets and seven VAGLAHS staff 

members who are located on site. Staff members facilitate 30 groups a week ranging from life 

skills training to 12-step programs to medication management groups. At 12 months, residents 

construct a transition plan to start the process of moving toward other permanent housing 

options. 

Residents pay a portion of the rent and must save money while they reside in Westside. About 30 

percent of the Westside beds are for residents who receive public benefits, while the remainder 

of the residents are employed. Westside also operates the Veterans In Progress (VIP) program. 

Individuals in this program become residents of Westside once they leave substance abuse 

treatment (such as those leaving the Domiciliary). The VAGLAHS through the Grant & Per 

25 Residents in SPC beds are not on the vocational track because these are reserved for people with multiple 

problems who are not expected to be able to work. 

26 If staff members are unable to find clients permanent housing solutions, they will refer people to Westside 

Residence Hall. 

D.16 
Appendix D: Los Angeles 

Diem funding pays for the veteran's stay in the residence until the person can find a job and 

become self-sufficienL 

Staff members estimate that most of the residents were chronically homeless individuals, many 

of whom have a history of substance abuse and/or mental health problems. Staff members assign 

one individual who is dually diagnosed with substance abuse and mental illness with two other 

individuals who do not have dual diagnoses within a suite of rooms. Living with other higher 

functioning individuals seems to improve the dually diagnosed person's level of functioning. 

To be eligible for residency at Westside, individuals must have 90 days sobriety. Westside uses a 

therapeutic community model and has zero tolerance polices for using substances. Residents are 

tested for drug use monthly. When a person relapses, staff members will fmd treatment options 

for the individual. If the individual refuses treatment, they try to fmd a sober living facility for 

the resident. If sober living options are also refused, the individual is on his own. An individual 

has to have 90 days of sobriety after the first relapse to return to Westside. After a second 

relapse, the individual must remain out of the residence for six months and receive substance 

abuse treatment. After a third relapse, the individual must remain out of the residence for a year 

and receive 90-day inpatient substance abuse treatment. Despite strict requirements, veterans will 

return to Westside even after a third relapse. 

Westside staff members also provide alumni services to ex-residents through support, continued 

case management, the use of the facilities, and structured activities. Many alumni continue to use 

the services offered. For example, Westside staff served meals to 1,000 people for Thanksgiving 

2002. It is particularly important for the programs to be available to veterans during holidays, as 

the relapse rate increases to about 10 percent during the holidays. The relapse rate during other 

times of the year is 3 to 5 percent. 

Employment 

V AGLAHS staff members aggressively work with formerly homeless veterans to help them find 

employment. The VAGLAHS itselfhires a number of formerly homeless veterans either directly 

or through the Compensated Work Therapy program. The VA also partners with AmeriCorps for 

jobs for formerly homeless veterans and hires about 7 or 8 formerly homeless veterans per year 

through this process. The veterans work as outreach workers on the street, in the Access Center, 

and in many other locations on the LA campus. In addition, the community agencies in the 

collaborative network all provide vocational services to veterans. 

Additionally, the VA also has a Therapeutic Employment Placement and Support Program - an 

adaptation of a nationally proven model based on Individualized Placement and Support (IPS). 

This program is staffed by a Job Developer who identifies jobs in the community for formerly 

homeless veterans and follows them on the job to provide job support when necessary 

Case Management 

The Discharge/Service History Database. The VA has an administrative requirement that a 

homeless veteran is only eligible for three complete treatment episodes in residential programs. 

D.l7 
Appendix D: Los Angeles 

I f a person requires more than three episodes in housing, then the V A is required to seek a 

waiver to continue services. To keep track, VAGLAHS·has developed a discharge/service 

history database for use with its partners. Participating agencies are able to see a person's history 

in the treatment system on a case-by-case basis. V AGLAHS programs in the collaborative 

network (including the partner agencies) submit data about each person they serve. In addition, 

V AGLAHS staff members frequently call programs to collect information about their enrolled 

participants. 

The discharge/service history data are used whenever a veteran enters a program. V AGLAHS 

program and partner agency staff members contact the V AGLAHS database coordinator to learn 

about a new enrollee's history of service receipt. If a person has reached the limit, staff members 

from the V AGLAHS and collaborating programs, as well as the veteran, come together in a 

clinical case conference to develop an approach to care to meet the person's needs at that point. 

If necessary, they will apply for a waiver. 

HUD-V ASH. The VA Supported Housing program (HUD-V ASH) is an intensive case 

management program for homeless veterans. The program serves 75 clients from the LA campus 

with two case managers who will follow clients for up to five years. Frequency of contact 

depends on the person's needs. Some clients are seen only once a month while others are seen 

every few days. The program does not take homeless veterans who are just off the street, but will 

take them once they become stabilized in some type of housing such as Westside Residence Hall 

or an Single Room Occupancy (SRO). 

Potential clients are screened extensively to ensure they are ready for the program. Eligible 

veterans must have six months sobriety and must be diagnosed with a substance abuse or mental 

health disorder. Although the clients are not eligible for HUD-V ASH until they are sober and 

somewhat stably housed, about 80 percent have been street homeless at one time and about half 

have been homeless more than once. About 80 percent of clients are dually diagnosed with 

substance abuse and mental health disorders. The program has an 80 percent success rate. The 

clients that are not successful either drop out of services or end up back on the street. 

The HUD-VASH program is a permanent housing case management program. The case 

managers are able to expedite the enrollment and eligibility process for the Housing Authority so 

all the HUD-V ASH clients are able to be housed in Section 8 apartments. Case managers go with 

clients to appointments at the Housing Authority and a specific staff person serves as the liaison 

for the HUD-V ASH program clients. Section 8 vouchers are eannarked for the program so 

clients do not have to wait. Clients receive vouchers within a few weeks after the application is 

submitted. The voucher attaches to the client and not the program, thus the extensive screening 

process before admittance into the program. 

Once clients have Section 8 vouchers it is very challenging to fmd landlords willing to accept 

them. Property owners can get rents above the fair market rent-$967 per month for a two 

bedroom apartment (U.S. Department of Housing and Urban Development, 2002). They do not 

want to accept less money for their properties and contend with the inspections required by the 

Housing Authority. The HUD-VASH case managers accompany the clients to assist them in 

locating housing and to advocate to landlords on the client's behalf. 

D.18 
Appendix D: Los Angeles 

Once in housing, the program includes mandatory monthly home visits. Other case management 

services include crisis intervention, family therapy, survival services, advocacY,.life skills 

coaching, as well as referral to employment and training and services, and in-home supportive 

homemaker services. The case managers work to identify and assist with all the client's needs. 

Case managers will refer people to the VA's Compensated Work Therapy Program or to 

volunteer work if the person has trouble fInding employment and training opportunities. The 

program staff members conduct random urine tests when they see clients on campus. If clients 

relapse, case managers will refer the person into treatment and make sure their rent is paid out of 

their VA benefIts so they do not lose their housing. Ifpeople cannot fInd an apartment, they lose 

their vouchers. 

St. Joseph's. St. Joseph's, a nonprofIt homeless service provider, is funded by the VAGLAHS to 

provide money management services to veterans. St. Joseph's staff members are located on the 

LA campus, making it convenient for veterans to use the service. The St. Joseph's staff members 

develop rapport and trust with the veterans to give them as much control over their money as 

possible and provide money management classes for veterans. V AGLAHS has documented that 

using money management reduces hospitalizations for homeless veterans. 

VAGLAHS Documenting Reductions to Chronic Street Homelessness 

Developing housing alternatives for veterans allows V AGLAHS staff to use inpatient medical, 

surgery, and psychiatric beds appropriately. (McGuire et aI., 200 I) show that increasing housing 

options for homeless veterans, along with other changes in the system, helped to reduce the 

length of stay in medical, surgical, and psychiatric beds between 1994 and 1998 (McGuire, et aI., 

2001). The length of stay was reduced in medical beds by 28 percent, in surgery beds by 7 

percent, and in psychiatric beds by 35 percent. Not only are programs assisting the VAGLAHS 

in decreasing the length of stay in its treatment and medical facilities, but the programs have also 

assisted the V AGLASHS so it is not discharging patients to the streets, from which they will 

quickly cycle back. Both community program and V AGLAHS representatives report that the 

collaborative allows them to serve veterans better, and in a more cost-effective manner. 

Staff members in community partner agencies and the V AGLAHS also believe that veterans are 

more likely to be successful in programs that are veteran-focused. Programs with mixed 

populations are more difficult for veterans. In veteran-specifIc programs, clients can identify 

with one another given the commonality of their experiences and the problems they may face as 

a result. 

Finally, the V AGLAHS is currently trying to understand the effectiveness of the services it 

provides and the effectiveness of the collaborative network. It is involved in four ongoing 

evaluations that will examine the impact of the collaborative network. First, it is part of a 

longitudinal study of veterans who leave residential care to examine housing stability. Second is 

a demonstration project examining the outcomes of the Access Center users. A third study 

focuses on homeless female veterans who are dually diagnosed with substance abuse and mental 

health disorders to compare residential and case management services only to residential and 

case management services along with cognitive therapy. A fourth study is examining individual 

D.19 
Appendix D: Los Angeles 

placement for seriously mentally ill veterans, comparing normal V A services with vocational 

rehabilitation to psychiatric vocational rehabilitation. 

Results are not yet available from these studies, but a national evaluation of VASH showed that 

over a three year period of time, the HUD-V ASH veterans spent 16 percent more nights housed 

than veterans receiving case management only and spent 25 percent more nights housed than 

veterans receiving standard care (Rosenbeck, et aI., n.d.). 

V AGLAHS Community Relations and Advocacy 

A V AGLAHS staff member is a member of the Community Police Advisory Board and attends 

meetings as a city resident and as a representative of the V A. Other VA staff members, including 

the director, attend city council meetings when a new building or program is opening or when 

there have been a particularly large number of complaints about homeless veterans. Other V A 

staff members attend neighborhood meetings to discuss the VA's plan and programs with the 

community and receive feedback. 

The V AGLAHS collaborative network faces some challenges. First, agencies are unable to serve 

all veterans because of the VA eligibility requirements. For example, veterans must have been in 

the service for two continuous years or have been in combat, and have a positive discharge status 

to be eligible for homeless services. Second, funding and services for women veterans are less 

available than for men. Third, funding for money management services, while present, is low. 

Finally, the V AGLAHS does not have a year-round emergency shelter for veterans. 

Focus group participants said: 

• 	 The VA services assisted them in getting offthe street and becoming clean and 


sober. 


• 	 The VA services provided many opportunities that they never knew existed. 

• 	 The VA staffmembers understand the difficulties veterans have and understand 


that many have criminal records because ofsubstance abuse histories, etc. 


• 	 Ifit wasn't for the VA services, some ofthem would not be alive today. 

• 	 It takes a tremendously long time to achieve stability after living with substance 


abuse and homeless ness for many years. 


• 	 Succeeding in services and succeeding at becoming self-sufficient requires 


patience. 


• 	 Even though they are successfully housed and employed, they are still only one or 


two paychecks from the street because ofthe difficulty finding affordable housing 


in Los Angeles. 


D.20 
Appendix D: Los Angeles 

Los Angeles County AB 2034 Program 

The Los Angeles County Jail has approximately 2,500 severely mentally ill inmates. Even 

though only 1 to 2 percent of the general popUlation suffers from serious mental illness, seriously 

mentally ill persons comprise 10 to 20 percent of prisoners and, at least 30 percent of people who 

are chronically homeless. In response to the number of homeless people that have a psychiatric 

disability but have been unable to access the traditional mental health system, including those 

who are caught in the revolving door of the criminal justice system, the California legislature 

passed AB 34 in October 1999 to fund a Demonstration Program in three California counties. 

The purpose of AB 34 was to provide outreach and integrated mental health services to seriously 

mentally ill persons who are homeless, recently released from county jailor state prison, or 

others who are untreated, unstable and at significant risk of incarceration or homelessness unless 

treatment is provided to them. 

LAC-DMH was one of the three counties selected to implement the AB 34 Program and had a 

target of enrolling 834 clients within six months. The goal of the AB 34 Program was to help 

these individuals integrate into the community and to improve their quality of life by reducing 

homelessness, psychiatric hospitalizations, and incarcerations and by obtaining benefits to which 

they were entitled and obtaining and maintaining employment. To implement the programs 

LAC-DMH initially selected 12 community-based mental health providers with extensive 

experience in providing integrated services to people who are chronically, severely mentally ill. 

Agencies selected had proven performance records with LAC-DMH by numerous years of 

collaboration with various on-going programs providing community-based integrated services. 

Special attention was paid to allocating funding to the eight service areas of Los Angeles County, 

proportionate to each area's level of poverty and homelessness, as determined by available data. 

After a successful f1[st year the AB 34 Program was expanded and changed from a pilot program 

to a normally funded program through AB 2034. The Program allocates on average $12,000 of 

State General Fund revenues per client annually, with flexibility to address the areas of housing, 

personal and incidental needs, vocational, and program/socialization needs in addition to more 

traditional therapeutic services to support and maintain the client's highest level of functioning. 

The AB 2034 Program sets no time limit on receiving services and assistance. Clients maintain 

service eligibility even after receiving Section 8 housing assistance. This program assists clients 

in learning self-sufficiency by teaching them how to access services. Clients are disenrolled from 

the program when they graduate, move out of the County, are unable to be located for 90 days, 

or are sentenced to prison for more than a year. 

LAC-DMH AB 2034 staff works closely with contract agencies to monitor performance and 

provide guidance and consultation. LAC-DMH holds bi-monthly meetings with the AB 2034 

providers to facilitate the development of a comprehensive and coordinated system of care for 

the target popUlation. LAC-DMH provides on-going training to AB 2034 providers to ensure that 

necessary resources are identified, developed, and utilized to assist in improving the AB 2034 

clients' quality of life. Additionally, the Housing Specialists meet monthly with the DMH AB 

2034 Housing Coordinator. 

0.21 
Appendix D: Los Angeles 

Table 0.3: AB 2034 Network of Agencies Involved in Ending Chronic Street Homelessness 

Homeless·Related Programs and Services 

OJ ;:, f if' 

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Nonprofit Programsl Servicesl Agencies Serving 

Currently or Formerly Chronic Street Homelessness 

People (listed Alphabetically) 

Lead Agency 

Los Angeles County Department of Mental Health FIFIFIFIFIFIFIF F I I F XlF X I X I F I F X X XlF I F 

Contracted Agencies 

Didi Hirsch CMHC X X X X X X X X X X X X X X 

Enki Health and Research Systems La Puente X X X X X X X X X X X X Enki Health and Research Systems Los Angeles X X X X X X X X X X X X Exodus Recovery, Inc. X X X X X X X X X X X X X X X 

Hillview Mental Health Clinic, Inc. X X X X X X X X X X X X X X X 

Kedren Community Mental Health Clinic X X X X X X X X X X X X X X 

Lamp Communily, Inc. X X X X X X X X X X X X X X X X 

Mental Health Association Lancaster X X X X X X X X X X X X X X 

Mental Heallh Association Long Beach X X X X X X X X X X X X X 

Pacific Clinics X X X X X X X X X X X X X 

Portals, Inc. X X X X X X X X X X X X X X 

SFV Community Mental Health Clinic, Inc. X X X X X X X X X X X X X X X 

South Central Health and Rehab. Prg (SCHARP) X X X X X X X X X X X X X X 

Special Services for Groups X X X X X X X X X X X X X 

Step Up on Second Street X X X X X X X X X X X X X X 

Telecare Corporation, Inc. Los Angeles X X X X X X X X X X X X X Telecare Corporation, Inc. Norwalk X X X X X X X X X X X X X Tn-City Mental Health X X X X X X X X X X X X X X X 

Verdugo Mental Health Center X X X X X X X X X X X X 

Shelter Partnerships XlE E E E E E X X XlE XlE XlE XlE 

X = Provider E = Expert Techical Assistance F = Funder 


0.22 
Appendix D: Los Angeles 

AB 203~Access to the System 

A critical component of the outreach effort is conducted within the criminal justice system. 

LAC-DMH AB 2034 clinicians are stationed at Twin Towers Correctional Facility (rrCF) to 

identify, evaluate and refer homeless seriously mentally ill inmates to one of the AB 2034 

contracted programs. To be referred, mentally ill inmates must meet the following criteria: 

• 	 Presence of a major Axis I diagnosis indicating serious and persistent mental illness; 

• 	 Homeless or at risk of becoming homeless, including living in a temporary shelter or 

crisis residential facility; 

• 	 Lack of a current prison sentence or other forensic hold; and 

• 	 Not currently connected to mental health services. 

All inmates identified as being mentally ill are housed in the mental health modules of rrCF. 

Some clients, however, reported during our focus group that they chose not to disclose mental 

illness at intake because they feared not being treated equitably in the mental health areas. 

Prospective clients are identified and referred by Jail Mental Health staff, the courts, and family 

members. Inmates scheduled for release who meet the eligibility criteria and have consented to 

participate in the AB 2034 Program are assessed and referred to one of the AB 2034 providers. 

Mentally ill inmates who do not meet all of the eligibility criteria are referred back to the 

referring jail mental health clinician. 

When a referral is made to providers, AB 2034 team members enter the jail and initiate an 

engagement process with the referred client that includes a thorough psychiatric and needs 

assessment. AB 2034 team members are expected to meet with their incarcerated AB 2034 client 

at least weekly, including attending court hearings to advocate for them and to work with the 

Sheriff's Department to coordinate an effective release/discharge plan from rrCF. When 

inmates leave the jail, AB 2034 team members are given discharge treatment summaries and 

prescriptions for medication, to ensure continuity in care in the community. 

At the time of release, AB 2034 case managers transport clients to predetermined living 

arrangements and continue to assist them in community integration. Even though the jail does 

not have a policy requiring housing upon release, the agencies participating in the AB 2034 

program are required to locate housing and provide transportation to wherever the client will be 

living upon release. If housing is not available in the client's desired area, he is placed close by 

and has the option of receiving outpatient treatment in the program of his choice until housing 

becomes available. Once in the program, the individual may transfer between programs as the 

need arises. 

Checks are in place to assure that the AB 2034 incarcerated client is not discharged to the streets. 

If the agency does not contact the Inmate Reception Center (IRC) within 48 hours prior to 

release to make transportation arrangements, the IRC staff contacts the AB 2034 office at the 

jail. There have been a few instances where the coordination of discharge planning was 

unsuccessful, especially where an AB 2034 client was court-ordered for an immediate release 

when their sentence was truncated. Also, during the site visit, respondents reported that 

D.23 
Appendix D: Los Angeles 

discharges would be smoother for AB 2034 clients if deputies and IRC staff were more familiar 

with the Program. However, one of the problems in educating deputies and IRC staff about the 

Program is that the supervisory staff varies from shift to shift and there is an on-going rotation of 

deputies in the IRC area. 

AB 2034-Housing 

All participating agencies provide assistance in obtaining_emergency, transitional and/or 

permanent housing for AB 2034 clients. Some agencies master-lease apartments or houses to 

provide emergency, transitional and/or permanent housing, while other agencies provide 

payments for shelters and SRO hotels. Most agencies provide temporary rental subsidies while 

clients await approval for General Relief, Supplemental Security Income or other benefits to 

secure housing. One agency has purchased two four-unit properties as permanent housing for 

clients. Overall, AB 2034 agencies emphasize providing housing at small apartment buildings or 

at scattered sites. 

The AB 34 Pilot Program demonstrated that finding and securing appropriate housing is a critical 

part of the program's overall success. LAC-DMH contracted with Shelter Partnership, Inc. to 

develop a housing strategy and to assist participating agencies in obtaining the skills necessary to 

effectively identify and secure appropriate housing for their clients. The agencies initially 

focused on understanding the importance of housing in the client's recovery process, and on the 

function of a housing specialist. LAC-DMH encouraged each agency to use allocated funds to 

hire or designate a staff person as a housing specialist. 

Under the guidance of Shelter Partnership, Inc., LAC-DMH assessed the training needs of agencies 

in order to design an educational program to equip the housing specialists with the skills necessary 

to identify and secure housing. As a result, the Adult Systems of Care Housing Coordinator 

conducts monthly meetings to provide training on topics such as master leasing, identifying 

available housing resources, developing partnerships with private, non-profit agencies, and 

marketing strategies. This meeting also includes opportunities for monthly problem-solving and 

networking. Networking continues outside these meetings, as housing specialists share referrals and 

housing leads on an informal basis. 

Affordable housing is a recognized need in Los Angeles and this is especially true for clients with 

criminal backgrounds who may not qualify for Section 8 housing, or who may be viewed as 

undesirable tenants. To recruit landlords willing to rent to AB 2034 clients, LAC-DMH hosted a 

landowner/property developer's breakfast during which a panel of speakers presented on topics 

such as the availability of low interest loans for the acquisition or rehabilitation of low income 

housing, the availability of mental health professionals that assess the mental health needs of 

tenants and offer assistance to avert possible eviction, fmancial incentives to rent to AB 2034 

clients, and rental subsidies through HUD. 

The Adult Systems of Care Housing Coordinator provides technical assistance to the agencies in 

completing applications for Section 8 housing vouchers. The Housing Coordinator scrutinizes 

each application thoroughly to ensure that it complies with HUD's eligibility guidelines and 

regulations in order to submit applications that will be approved. The Housing Coordinator also 

D.24 
Appendix D: Los Angeles 

works with the Los Angeles City and County Housing Authorities on a case-by-case basis to 

advocate exemptions for clients with criminal histories. 

The Housing Authority of the City of Los Angeles, through its Special Needs Program, is able to 

provide housing vouchers as early as two weeks after the submission of a Section 8 application. 

However, those waiting for vouchers either from Los Angeles County or from the City of Long 

Beach have a much longer wait-sometimes nine months to a year for the County or as long as 

seven years in Long Beach. When a client applies to the Long Beach City Housing Authority for 

a Section 8 voucher, the client can still face an extended period on the waiting list even after an 

application is accepted because vouchers are distributed using a lottery system. Upon receiving a 

housing voucher, the client still faces the daunting challenge of finding a place to live. 

Frequently, the Housing Specialists acting on a client's behalf must apply for an extension 

because the client cannot locate housing during the time the housing voucher is valid. 

Not all of the problems faced in securing Section 8 housing are directly related to AB 2034 

clients. Property owners are resistant to becoming Section 8 providers due to the bureaucracy 

and the housing market. Depending on the particular Housing Authority, it may take several 

months for the Housing Authority to inspect a site once the landlord's application is received. 

Frequently, prospective landlords are not willing to wait for inspections or wait for an extended 

period of time before receiving their fIrst rent check from the Housing Authority. This is 

particularly true in a tight housing market in which property owners could rent a building very 

quickly outside the Section 8 program. 

AB 2034 funds give Housing Specialists the flexibility to overcome property owner resistance by 

employing such innovative strategies as paying the Housing Authority's portion of the rent until 

the landowner receives hislher rental subsidies, offering to pay a slightly higher security deposit 

and placing an early deposit on a housing unit so the property owner will have funds available to 

make necessary repairs to bring the building up to Section 8 standards. The Housing Specialists 

can also intervene if an eviction is imminent or use AB 2034 funds to repair damage done by a 

client. In addition to fmancial incentives, AB 2034 agencies offer 25-hour on-call services to 

intervene if a problem should arise. 

AB 2034-Documenting Reductions to Chronic Street Homelessness 

One of the strong points of the AB 2034 program is its ability to collect real-time data. AB 2034 

Program (CAMINAR) data system, self-reported case level baseline data is collected on each 

client for a 12-month period prior to enrollment into the AB 2034 program. A client's record is 

then updated each time there is a status change and again annually. Status changes include 

changes in place or type of residence, hospitalizations, incarcerations, and changes in 

employment. In addition, objective quality-of-life indicators are collected in the areas of 

residence, employment, education, criminal activity, income, control over one's own life 

(conservator/payee), social support, and physical health. 

The following data from the "AB 34/2034 Program One Year Outcomes" report is based on 720 

Los Angeles clients who are or were in the program for at least one year. It compares data from 

the 12 months prior to enrollment to 12 months after enrollment in the program. There was a 77 

percent increase in permanent housing, 65 percent decrease in number of days consumers were 

0.25 
Appendix D: Los Angeles 

homeless, 65 percent reduction in number of consumers incarcerated, 62 percent decrease in 

number of incarcerations, 80 percent decrease in total days of incarceration, 33 percent reduction 

in number of hospital admissions, and 74 percent decrease in total number of hospital days. 

With the expansion of the Program in FY 2000-2001, LAC-DMH selected four additional 

community-based mental health providers to participate in the AB 2034 Program. The AB 2034 

program now contracts with 16 agencies at 20 locations within Los Angeles County. See Table 

D.3 for a complete list of contracted providers. 

AB 2034-Model of Care 

The principal philosophical component of both the Assertive Community Treatment (ACT) and 

Integrated Service Agency models is the use of non-traditional methods to achieve the desired 

goal of outreach and engagement of the hard-to-reach mentally ill population. Through 

utilization of an ACT model, the AB 2034 Program ensures a comprehensive response to the 

needs of the client. Since AB 2034 services are provided "where the client is" in the community, 

AB 2034 team members spend the majority of their workday in community locations such as 

jails, parks, shelters, dual diagnosis recovery homes, emergency rooms, social services agencies, 

and/or wherever homeless individuals congregate. 

Program Components-San Fernando Valley Community Mental Health Center 

We visited one AB 2034 contracted agency in Los Angeles County that receives a large number 

of AB 2034 jail referrals-The San Fernando Valley Community Mental Health Center 

(CMHC), Inc., which we use as an example in our discussion of program components. 

San Fernando Valley Community Mental Health Center, Inc. The San Fernando Valley 

CMHC operates one of the AB 2034 programs in Los Angeles County. Its program approach 

includes an integrated community care system providing intensive case management services for 

homeless mentally ill individuals who were recently released from jail and who are at risk for 

recidivism (Hunter et aI., 2002). The Center's AB 2034 Program, located at the Cornerstone 

Multi Service Homeless Drop-In Center, serves about 105 clients in a year, although its DMH 

contract is to serve 78 clients. 

Staff members provide comprehensive services and case management to meet client needs and 

collaborate with other community agencies as needed. The staff members estimate that many of 

the AB 2034 clients have been on the street, sometimes for many years. San Fernando Valley 

CMHC is able to accommodate the housing needs of the AB 2034 clients through the program's 

own master leased transitional housing sites, the Center's satellite townhouse apartments, or 

through the Center's Independent Living Program's Section 8 contract with the City of Los 

Angeles. 

Outreach 

The program receives referrals from the Los Angeles County jail for 80 percent of its clients. 

Referrals also come from emergency shelters in Los Angeles County, hospitals, parole, 

D.26 
Appendix D: Los Angeles 

fonn, offering a full continuum of services from outreach to permanent independent housing at 

several locations within Skid Row. 

L.A. Men's Place was not overtly an abstinence-based program when it opened although it 

encouraged sobriety and referred its members to local drug and alcohol treatment programs. It 

soon discovered that mentally ill persons had difficulty with 12-step programs because they were 

not allowed to take prescription medications. Consequently, it developed its own drug treatment 

program with funds from the County Department of Mental Health and developed the hannreduction model of treatment. 

In 1985, L.A. Men's Place shortened its name to LAMP to be more inclusive ofwomen, and in 

recent years changed its name again to Lamp Community to reflect the community approacb to 

working with homeless men and women. 

Lamp Community Model 

Lamp's Community Model27 uses a low demand philosophy and fosters a sense of life-long 

community by offering multiple levels of housing, street outreach, and employment 

opportunities with a high degree of client participation in programmatic decision-making 

processes. Many staff members are program participants. The program specifically tailors itself 

to serving homeless individuals with chronic mental illnesses by employing a non-linear housing 

model with voluntary supportive services. Lamp refers to its clients as members and its case 

managers as advocates. Lamp considers that an individual is successful when he does as much as 

he can do at that time. Based on tills philosophy, individuals have no failures. 

Lamp Community Components 

Although the individual components of Lamp Community operate independently, they also 

interconnect with one another. Members have the option of using different combinations of 

services and housing, moving among the various components within the community as the need 

arises. Lamp Community also collaborates with many other agencies to provide services, 

housing, and employment for its members. See Table D.4 for a complete list of these agencies. 

Street Outreach 

Although not a specific component of the Community Model, street outreach provides access 

into the community. Lamp does not need to conduct outreach activities in "The Row" because 

homeless individuals on "The Row" already know about Lamp Community and have access to 

its Drop-In Center. Historically, outreach is conducted primarily in the business districts and is 

commonly (although not exclusively) done in cooperation with Los Angeles System-wide 

Mental Assessment Response Team (SMART) collaborative units. These are specialized units 

27 Much of the infonnation in this section is from The Philosophical Framework ofthe Community Model: an 

Approach to Providing Comprehensive Housing and Services to Homeless Individuals with Chronic Mental 

Illness, Lamp Community 2002. Los AngeJes. 

0.29 
Appendix D: Los Angeles 

consisting of police officers and licensed clinicians from the Department of Mental Health that 

respond to police calls having a mental health related component. Lamp provides specialized 

training to the police officers on the SMART team on methods for approaching and engaging 

homeless mentally ill persons. 

Typically, the SMART team contacts the Lamp outreach workers when they identify a homeless 

person with mental illness who is not in need of hospitalization. Lamp then attempts to engage 

the individual to accept services, using the harm reduction approach of meeting a person "where 

he is at" and doing whatever it takes to link the individual to services. If the individual is 

unwilling to come in off the streets, Lamp provides street case management, even accompanying 

the member to appointments if needed. Lamp outreach workers contact the SMART team when 

they fmdan individual who is assessed as needing hospitalization, but is unwilling to go. 

Lamp also provides outreach services at the Twin Towers County Jail. Prior to the inception of 

AB 2034, Lamp Community was the primary referral agency for clients from the jail, receiving 

about 40-60 referrals each week. However, since the implementation of the AB 2034 program, 

Lamp now receives 8-12 referrals each week, as more jail inmates are referred to program 

partners throughout the county. One of the hallmarks of Lamp is that it does not tum anyone 

away. Unlike other AB 2034 programs, Lamp Community will continue accepting prospective 

members from the jail even after reaching its maximum capacity of AB 2034 clients. 

Recently, Lamp has scaled back its outreach activities due to diminishing funding and resources. 

Now outreach is more concentrated on AB 2034 clients at the jail and hospitals, at other 

homeless agencies and shelters, and at board and care homes. Lamp members interviewed report 

connecting to Lamp through referrals from other agencies, the police, the jail, lind through 

Lamp's Drop-In center. 

Interviews with outreach workers indicate that the "hook" to engage homeless individuals is 

food. Outreach workers distribute sack lunches as part of their outreach activities. This takes care 

of an immediate need for the homeless person and provides an avenue for engagement. Other 

dimensions of the engagement process include: 

• 	 Establishing a trusting relationship and identifying the individual's self-perceived 

immediate needs; 

• 	 Providing concrete goods and services such as toiletries, clothing, or transportation; and 

• 	 Addressing clinical, social service, and other supportive service needs as appropriate. It 

is not unusual for an individual to be willing to accept case management services on the 

street but not be willing to come in from the cold. Low Demand Transitional Housing 

D.30 
Appendix D: Los Angeles 

Table D.4: Lamp Community Network of Agencies Involved in Ending Chronic Street Homeles

Homeless-Related Programs and Services 

f>i 

Qi:! 

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:oS o :oS b 

.§ ;! .l 'Ii 0- .r::- & 'D § ;:: f..::. ",0 ff f %4:::­ Q. :J: Q:' 

Nonprofit Programs! Services! 

Agencies Serving Currently or 

Formerly Chronic Street Homeless 

People (listed alphabetically) 

Lamp Community x x x X,F x I X,E x E x x IX,EI X,E X x x 

Skid Row Housing Trust X X x X I X X 

Volunfeers of America X IX X X x X 

Mental Health Association X X,E X X X I X I X I X I X,

Shelter Partnership X,E I I E E E E E X X,EI X,E I X,E IX,EI X

E,F E,F X,E \.E1 X,E,F IX,E,FI X,Elx,E

Corporation for Supportive Housing 

Los Angeles County Dept. of Mental X IF,XI F F X,E,F X X,E'IX,E

Health F 

Prototypes X X X,EI X,E X,E x x X,E 

Homeless Healthcare LA X,E X X,E X,EI X,E I I X 

L.A. Coalition to End Hunger and X,E X,E X,EI X,E X,E IX,E 

Homelessness 

AIDS Healthcare Foundation X 

John Wesley County Hospital (JWCH) X X I X x 

Government Programs! Services! 

Agencies Serving Currently or 

Formerly Chronic Street Homeless 

People 

Los Angeles Homeless Services Authority IX,E, I X,F I F I F I F F F F X, E1 X,E,F IX,E,F X,E

(LAHSA) F ,F 

Los Angeles Police Department X X,E 

L.A. County-University Of Southern 

California Medical Center 5P21 (LAC-USC X 

5p21) Clinic 

x = Provider E =Expert TA Provider F = Funder 

D.3l 
Appendix D: Los Angeles 

Lamp Community was one of the original save haven providers that worked with HUD in the 

early 1990s to develop the defmition of a save haven in the StewartB. McKinney (now 

McKinney-Vento) Homeless Assistance Act. Although the McKinney-Vento Act defmes a save 

haven in terms of a funding program, providers are able to decide on specific methods of 

implementation. For example, save havens are required to provide low-demand services, but the 

level of expectations and rules vary among programs. Lamp's Respite Shelter! Drop-in Center 

operates as a save haven using a harm reduction approach. 

The Lamp philosophy furthers the belief that substance abuse is a health issue rather than a legal 

one. People under the influence of drugs and alcohol may enter the save haven but using illegal 

substances on the premises is prohibited. Within this framework, certain behavioral expectations 

exist. Members must respect each other and the staff, and must refrain from violence to property 

and other people. Any rule violation results in temporary exclusion from the site for specific 

amounts of time ranging from several hours to several weeks. 

The drop-in component of the save haven is the point of engagement into Lamp's community. 

This is where homeless persons can come for food, showers, telephones, and supportive services, 

or simply to socialize with other members or staff members. Even though services are voluntary, 

members are encouraged to complete an intake interview during which their medical, 

psychological, and substance abuse histories are assessed upon entry into the save haven. Staff 

Advocates make themselves available to members and remind them of activities that are taking 

place throughout the Lamp Community. 

In its current configuration, the first floor of the save haven serves as a drop-in center in the 

daytime and a respite shelter at night. In the evening, 12 semi-private bed spaces are set up on 

the first floor and six beds are set up on the second floor. An additional 13 beds are available at 

the Ballington Hotel, which is adjacent to the Drop-in Center. Shelter guests pay a voluntary fee 

if they receive SSI or welfare benefits. Members who can care for an apartment and share a room 

with another person are encouraged to stay at the Ballington. All beds are available on a fustcome, first -served basis. If members do not return to the shelter by a certain time of night, they 

forfeit their bed. 

The staff at the save haven consists of a program director, eight full-time and two part-time staff 

members, and one relief person. Many staff members are former or current members who work 

as "Peer Advocates." A contracted psychiatrist from the Los Angeles County Department of 

Mental Health also visits once a week. 

Lamp Community Housing 

Housing options at Lamp are more flexible than those found in traditional programs. Lamp offers 

both transitional and permanent housing, with supportive services attached to both. However, in 

keeping with its philosophy, supportive services are optional. Members have the option of 

moving from one housing program to another, as need dictates, without jeopardizing their place 

within the community. Lamp believes that housing is a right, not a privilege, so housing is not 

contingent upon sobriety or accepting services. 

0 .32 
Appendix D: Los Angeles 

Transitional Housing. Lamp's transitional housing is structured and well suited for individuals 

who prefer a structured environment wbile addressing their health issues, particularly substance 

addictions. In addition to the basic rules of no violence, no stealing, and no drug use, there are 

additional rules such as curfews, quiet hours, and permission to leave overnight. The transitional 

housing program also requires members to commit to a contract (called a service plan) in wbich 

they establish a set of self-initiated goals, and to commit to a treatment plan. Those who choose 

to work on reducing their substance addiction are asked to stay voluntarily on the housing 

premises except for chaperoned outings for 30 10 90 days in order to separate themselves from 

the culture of drug use on the streets. 

At Lamp, transitional housing is more than simply a bridge between emergency shelter and 

permanent supportive housing. It is transitional in the sense that some members will transition to 

permanent supportive housing wbile other members may wish to remain there indefmitely. Due to 

the cyclical nature of mental illness and substance addiction, some members leave their 

permanent home temporarily to stay in the transitional housing program in order to live in a more 

structured environment wbile working on specific aspects of their recovery. Once stabilized, they 

are able to return to their permanent home. 

The transitional housing program is at Lamp Village, a 50-bed facility with semi-private 

accommodations. Staff includes a Program Director, eight full-time staff, one part-time staff, and 

one relief person (called a rover). 

Permanent Supportive Housing. Lamp's permanent housing is much less structured than its 

transitional housing program and offers the highest degree of privacy of any of its housing 

programs. Participation in activities and services is not mandatory but many members maintain 

connections with their advocates and participate in services connected to the save haven and the 

transitional housing program. 

Lamp offers three supportive housing facilities all within walking distance of the other Lamp 

facilities. Lamp Lodge, wbich Lamp Community owns and operates, provides 43 studios and 7 

one-bedroom apartments all fully furnished with full baths and kitchens. Lamp master leases 10 

units at the Ballington from the Volunteers of America. These are partially furnished apartments 

with full baths. Lamp also holds 17 units at the Pershing Hotel in collaboration with Skid Row 

Housing Trust. These are single room occupancy rooms consisting of a small sleeping-living 

area with shared kitchen and bathroom facilities outside the units themselves. These units are 

reserved for Lamp members under a special agreement between Lamp Community and Skid 

Row Housing Trust. Additionally, Lamp members occupy auother 10 market-rate units at the 

Pershing. Unlike the Ballington where Lamp holds the lease for the tenants' rooms, the tenants at 

the Pershing enter into a lease agreement directly with Skid Row Housing Trust. Lamp is 

currently planning several other collaborative housing programs with other local nonprofit 

housing developers with the goal of making an additional 100 units available to homeless 

persons by 2005. 

A Housing Program Director oversees all the independent housing programs. Additionally, 

Lamp places resident advocates with a caseload of 15 tenants each to provide support services at 

both the Ballington and the Pershing Hotels. The Lodge Manager has one part-time and one fulltime advocate on staff with a case load of 15. 

0 .33 
Appendix D: Los Angeles 

The Pershing Hotel, managed by Skid Row Housing Trust, also offers case management services 

to its tenants but at a ratio of approximately 40: 1. The Pershing residents can use Lamp's 

advocate services at a lower intensity than the Lamp members; they frequently ask to become 

members of the Lamp Community. At this point, they get thorough screening for the presence of 

mental illness, and are accepted into the community if certain criteria are met. 

Skid Row Housing Trust staff members reported that the key to housing mentally ill persons is 

close relations with the mental health provider and enhanced property management services, 

particularly over the weekends when member advocate services may not be available. Lamp 

meets weekly with the property managers at the Pershing to discuss property management and 

case management issues. 

Member-Operated Business and Other Employment Services 

Member employment is a unique feature of the Community Model. The Lamp Community 

businesses include a linen service, showers, toilets, and a laundromat. The linen service provides 

clean linens to local nonprofit hotels, shelters, and other businesses. It employs 20 members and 

maintains a waiting list of prospective member employees. Lamp's showers and toilets are open 

to the Public. One or two member employees oversee the operation. Lamp's laundromat is the 

only laundromat open to the public in the Skid Row area. Lamp Community employs eight 

members between the laundromat and public showers. 

Lamp also employs six members as advocates to provide case management and advocacy 

services. Peer Advocates receive training in ethics and confidentiality, professionalism, 

boundaries, case management, suicide and homicide interventions, and other crisis interventions. 

Supportive Services 

Lamp provides a wide array of voluntary supportive services. Most are components of the 

transitional housing program and the drop-in center but are available to all members. Members 

residing in independent housing must go to Lamp Village, which is within easy walking distance 

of their residences, to receive services that their resident advocate cannot provide. Lamp 

members are referred to outside agencies for medical and dental services. 

Lamp advocates report that immigration status and language barriers increase the difficulties in 

linking members to outside services. Without appropriate citizenship documentation, it is 

impossible to get public assistance for housing or medical services. Finding mental health 

services for foreign speaking persons is challenging at best. 

Lamp offers the following services: 

• 	 Money management and a Representative Payee Program for SSI benefits: Lamp will act 

as representative payee for individuals receiving SSI benefits upon request. This is not a 

requirement for the program, rather a service offered to the members. Additionally, 

Lamp will manage a member's money. The member "deposits" his money into an 

D.34 
Appendix D: Los Angeles 

account, Lamp then draws on this account to pay bills or give the individual the money 

needed to pay specific bills and/or provide the member with a weekly allowance. 

• 	 Meals, clothes, hygiene products, showers, and laundry facilities for their members as 

needed. However, the laundry facilities and showers are open to the public. 

• 	 Mental health services: these include group and individual counseling, psychiatric 

diagnosis, and medication management. 

• 	 Voluntary drug testing: some members choose to participate in voluntary drug testing as 

part of their approach to recovery. The ability to participate in programs or housing 

options is not dependent on either participation in voluntary drug testing or upon its 

results. 

• 	 Psycho-educational groups: Lamp offers groups related to harm reduction education, 

health, and drug education, and relapse prevention. 

• 	 Support groups: several 12-step recovery groups happen every week. 

• 	 Case management: this is a large component of member advocacy. In addition to 

benefits advocacy and referrals to necessary services outside the Lamp Community, 

Lamp also provides specialized HIV case management. A valuable component of case 

management is that the advocate will do whatever it takes to get services for members, 

often accompanying members to appointments until they can do this independently. 

• 	 Employment training and placement: 90 percent of staff members at Lamp's three 

businesses are member employees; half of Lamp Community employees are former or 

current members. 

• 	 Socialization activities: Lamp offers frequent opportunities for social and recreational 

outings and events, creating an atmosphere of community. A member of the focus group 

commented that Lamp has the best parties, especially during the holidays. 

• 	 Art and performance instruction: The Lamp Art Project includes a professional level art 

studio, serving members from beginners to bighly advanced artists. Field trips to 

working artists' studios, museums, public murals, and places of natural beauty are open 

to all members. 

Lamp Community-Documenting Reductions to Chronic Street Homelessness 

Lamp currently does not have a computerized database of all of its members although it does 

collect several measures at the point of intake for all members. Lamp is in the process of 

expanding to all its participants the CAMINAR database program that it uses to keep data for the 

AB 2034 program. Lamp does have data on members associated with the AB 2034 program, and 

data associated with other specific grants. 

D.35 
Appendix D: Los Angeles 

Lamp's AB 2034 data demonstrate a 59 percent decrease in incarceration days and a 79 percent 

reduction in time spent homeless on the streets among_ the members served through the AB 2034 

jail outreach program. 

Data for people benefiting from the California Department of Mental Health Supportive Housing 

Initiative Act (SHIA) Supportive Housing Project indicate that 87 percent of program 

participants (those residing at the Pershing and the Ballington) remain housed after one year, 7.7 

percent are injail, and the whereabouts of 5.1 percent are unknown. Participants in the study 

realized a 57 percent decrease in acute hospitalization incidents over a period of one year. All of 

the permanent housing residents enrolled in the project consistently participate in mental health 

treatment and 89 percent of the residents with active drug or alcohol addictions participate in 

recovery groups and related services. 

Separate data based on 2002 statistics on all residents at the Pershing indicate that 85 percent of 

the residents remained stably housed at the Pershing at the end of one year. Unfavorable reasons 

for leaving were due to either eviction (4.5 percent) or abandonment (3.0 percent). Favorable 

reasons for leaving included moving to a better apartment (3.0 percent), moving into a recovery 

program (3.0 percent) or moving in with family (1.5 percent). 

Lamp Community-Community Relations and Advocacy 

Gentrification of Skid Row is having an impact on the available housing and services to 

homeless individuals in the area. Consequently, the acceptable area for homeless individuals to 

spend their time during the day is shrinking as the vacant apartment buildings and warehouses 

are converted into market rate (i.e., expensive) lofts. Although the executive director of Lamp 

Community reports that NIMBY is not an issue in Skid Row, -tensions between several Business 

Improvement Districts in the area and homeless advocates in Skid Row persists. "Not in MY 

Backyard" is turning into "not in YOUR Backyard" reports an executive from Skid Row Housing 

Trust, as he describes the attitude of the developers who are moving into Skid Row. The 

developers do not want homeless individuals loitering around buildings and they work diligently 

with the police to move homeless individuals away from properties. In response to this, the more 

advocacy-driven board members of Skid Row Housing Trust worked with the American Civil 

Liberties Union (ACLU) to pursue lawsuits against the police and private security guards "who 

were acting more like Gestapo than police. " The courts granted a temporary restraining order 

against the police this spring to prohibit unlawful sweeps of Skid Row in search of probation and 

parole violators without reasonable suspicion. 

D_36 
Appendix D: Los Angeles 

Los Angeles Site Visit Participants 

- ,. ­ - -; - - ." ~, -" - - - -

- - -

Celina Alvarez L.A. Men's Place Community 

Michael Alvidrez Skid Row Housing Trust Property Management Co. 

Deirdre Anderson Portals, Mental Health Rehabilitation Services Community Living Program 

Judyth Balhesteros LA Men's Place Community 

John Best L.A. Men's Place Community 

Joan Brosnan VA West Los Angeles Health Center 

Marla Brundies VA West Los Angeles Health Center 

Tracee Cameron VA West Los Angeles Health Center 

Adam Chid eke I Portals 

Donald Coopentu L.A. Men's Place Community 

Debra Dyckoff VA West Los Angeles Health Center 

Sharon Eddington L.A. Men's Place Community 

Raul Jr. Espinosa VA West Los Angeles Health Center 

Craig Fenner Skid Row Housing Trust Property Management Co. 

Robert Fiese Portals, Mental Health Rehabilitation Services 

Diane Figgins Villiage USA 

Bob Friedman Greater Los Angeles Department of Veterans Affairs 

Mara Funk County of Los Angeles Department of Mental Health Adult Systems of Care 

Peter Graves VA West Los Angeles Health Center 

Vivian Hiver VA West Los Angeles Health Center 

Curley Holden Step Up on Second 

Karen Howard Department of Veterans Affairs 

James Howat Volunteers of America 

Mary Taylor Johnson VA West Los Angeles Health Center 

D.37 
Appendix D: Los Angeles 

Chu Kim County of Los Angeles Department of Mental Health Adult Systems of Care 

Anthony Leon Los Angeles County Sheriffs Dept. 

Mollie Lowery L.A. Men's Place Community 

Nick Maiorino St. Joseph Center 

Marquita McBride VA West Los Angeles Health Center 

Jim McGuire Homeless Program 

Gerald N. Minsk L.A. Men's Place Community 

Herman Jr. Mitchell VA West Los Angeles Health Center 

Willie Montgomery Department of Veterans Affairs 

Shannon Murray L.A. Men's Place Community 

John Nakashima Department of Veterans Affairs Los Angeles Ambulatory Care Center 

Anita Nazareth San Fernando Valley Community Mental Health Center, Inc. 

Thomas Ola VA West Los Angeles Health Center 

Anthony Oliver San Fernando Valley Community Mental Health Center, Inc. 

Dwight Raocliff United State Veterans Initiative (US Vets) 

Toni Reinis New Directions Inc. 

Cathy Aryon Rice St. Joseph Center 

Mary Richards VA West Los Angeles Health Center 

Eluid Rivera Los Angeles Sheriffs Department 

Stuart Robinson L.A. Men's Place Community 

Bonnie Roth San Fernando Valley Community Mental Health Center, Inc. 

Marie Tavares L.A. Men's Place Community 

Reina Turner Los Angeles County Department of Mental Health Adult Systems of Care 

Don Watts L.A. Men's Place Community 

Lee Wessof San Fernando Valley Community Mental Health Center, Inc. 

Faye Williams ENKI Health & Research Systems 

D.38 
Appendix D: Los Angeles 

Tamika Woodard VA West Los Angeles Health Center 


Betty Zamost VA West Los Angeles Health Center 


D.39 
- ----- -

Appendix D: Los Angeles 

Los Angeles Acronyms 

AB 

ACT 

ACLU 

CAMINAR 

CHALENG 

CMHC 

FTE 

HUD-VASH 

HCHV 

IPS 

IRC 

JMH 

JWCH 

LAC-DMH 

LAHSA 

SHIA 

SMART 

SRO 

TTCF 

VIP 

VAGLAHS 

WLAHC 

Assembly Bill 

Assertive Community Treatment 

American Civil Liberties Union 

The data collection system used by the AB 2034 program 

Community Homelessness Assessment, Local Education, and Networking Groups 

Community Mental Health Center 

Full Time Equivalent 

The VA Supported Housing Program 

Health Care for Homeless Veterans 

Individualized Placement and Support 

County Jail Inmate Reception Center 

Jail Mental Health 

John Wesley County Hospital 

Los Angeles County - Department of Mental Health 

Los Angeles Homeless Services Authority 

Supportive Housing Initiative Act 

System-wide Mental Assessment Response Team 

Single Room Occupancy 

Twin Towers Correctional Facility 

Veterans In Progress 

VA Greater Los Angeles Healthcare System 

West Los Angeles Health Care 

0.40 
APPENDIX E: PHILADELPHIA 


Philadelphia-Brief Description 

Philadelphia is the nation's 5th largest city, with a population in 2000 of 1.5 million. The city has 

been losing population28 and experiencing economic disinvestment for several decades. Between 

1973 and 1993 the city lost 200,000 jobs, and housing vacancies soared. Although a major 

reinvestment effort during tlJ.e 1990s slowed that decline and revitalized downtown and many 

residential neighborhoods (Kromer, 2001), the city still faces circumstances that generate 

homelessness. Its 2000 poverty rate was twice that of the nation as a whole (22.9 versus 11.3 

percent) and its average 2002 unemployment rate was also higher (7.5 versus 5.8 percent)?9 

Along with a few other cities (such as Baltimore, New York City, St. Louis, San Francisco), 

Philadelphia is its own county, with city agencies serving both city and county functions. 

Political will, supported by advocacy and coupled with control of city and county public 

resources, prompted Mayor Wilson Goode in 1988 to create the Office of Services for the 

Homeless and Adults. The office director eventually became a "homeless czar," a position that 

next two mayors have maintained and expanded. The current "czar's" official designation is the 

Deputy Managing Director for Special Needs Housing. Having someone in this position means 

there is a single person whose obvious job it is to resolve issues about homeless services. This is 

the Mayor's point person on homeless issues, held responsible for emergency shelter directly but 

also expected to interact with mainstream systems and coordinate activities more broadly to 

address homelessness. Through this office and in partnership with a strong array of providers, 

advocates, and businesses, the city has planned for and subsequently undertaken extensive 

investment in programs and services to end homelessness. 

A major focus of Philadelphia's efforts has been people experiencing chronic street 

homelessness. The network of programs and services developed to encourage people to move 

from the streets into housing includes extensive outreach, entry-level safe havens and other no 

demand residences, emergency shelters, transitional housing programs, permanent supportive 

housing programs of various configurations, and supportive services purchased from or supplied 

directly by city agencies. These latter services include outreach, mental health and substance 

abuse treatment and intensive case management, and primary health care. Pennsylvania, and 

therefore Philadelphia, still makes some public cash benefits available to disabled single 

individuals, and local public funds are used to meet some material needs (such as furniture, 

move-in money) and provide some rental assistance for families. Community development 

corporations (CDCs), including several created and run by homeless assistance providers, have 

been active in creating affordable housing that may be occupied by formerly homeless and other 

households. 

28 1970-2000, -22.2 percent; 1990-2000, -4.3 percent; 1980-1990, -6.0 percent; 1970-1980, -13.4 percent. 

Calculated from data obtained at www.census.gov/population/cencountslpaI90090.txt; accessed March 23, 2003. 

29 2000 poverty statistics for Philadelphia, quickfacts.census.gov/qfdlstatesl42/421 0 1 Ihtm1; for United States, 

quickfacts.census.gov/statesJOOOOO.html; 2002 unemployment statistics for Philadelphia, 

www.bls.gov/ro3/fax_9527.pdf; for United States, www.bls.gov/cpslhome.htm#overview. All accessed March 

22,2003. 

E.l 
Appendix E: Philadelphia 

On our visit to Philadelphia on March 17-20,2003, we interviewed almost 90 people. They 

represented city agencies; nonprofit outreach, drop-ill, shelter, and housing providers; agencies 

serving homeless people through casework, mental health and substance abuse treatment, health 

care, and job readiness/training/employment; community development/neighborhood 

revitalization organizations; legal aid, housing, and other advocacy organizations; and data 

managers and analysts. People who had experienced chronic street homelessness were included 

in a separate focus group. A full listing of persons interviewed, other than focus group 

participants, may be found at the end of this appendix. 

The next section describes Philadelphia's approach to ending chronic street homelessness, 

including documentation of progress to date. Thereafter we give more detail on selected system 

components, examine funding mechanisms, describe how the current system evolved and where 

it is going, and describe issues that have arisen with respect to community relations. 

Practices of Potential Interest to Other Jurisdictions 

• 	 Concerted plan to address street homelessness. In response to the Sidewalk Behavior 

Ordinance, Philadelphia instituted a serious, focused effort to develop the strategies and 

programs that would help people move off the streets and out of homelessness. The 

strategy involves an organized outreach effort, development of safe havens, and 

expansion of permanent supportive housing. (Contact person: Rob Hess, Deputy 

Managing Director, robert.hess@phila.gov.) 

• 	 Major investments by mainstream agencies. Philadelphia makes a serious commitment 

of public funds to homeless programs and services, over numerous departments and 

administrations, aided by continuing public support. (Contact person: Rob Hess, Deputy 

Managing Director, robert.hess@phila.gov) 

• 	 Outreach Coordination Center (OCC). The OCC offers a coordinated point of contact 

for street homeless people. Outreach workers linked to the OCC are able to offer a wide 

array of services, and feel confident that the people they contact will receive the services 

if they are willing to accept them. The OCC also maintains a database of contacts with 

street homeless people that give Philadelphia an excellent picture of who is out there and 

what their needs are. (Contact person: Genny O'Donnell, Director, Outreach 

Coordination Center, gennyodonnell@projecthome.org.) 

• 	 Single point of responsibility for homeless issues, and extensive coordination 

mechanisms. The position of Deputy Managing Director for Adult Services consolidates 

responsibility for planning, organizing, and delivering programs and services to end 

homelessness in Philadelphia in one obvious place. The Director and Adult Services are 

aided in their mission by the network of coordination mechanisms in the city, including 

its own data system and Housing Resource Center, the OCC, housing/neighborhood 

revitalization through the Office of Housing and Community Development (OHCD), 

Behavioral Health System through (BHS), primary health services through the 

Department of Public Health (DPH) and the Philadelphia Health Management 

Corporation (PHMC), and planning and implementation through the Mayor's Task Force 

E.2 
Appendix E: Philadelphia 

and the Blueprint. These arrangements appear to work well-people know whom to call, 

for both individual client advocacy and more programmatic issues. (Contact person: Rob 

Hess, Deputy Managing Director, robert.hess@phila.gov.) 

• 	 Data collection, analysis, and use to shape policy. To aid its planning and coordination 

efforts and its decision making about new investments, Philadelphia makes good use of 

its extensive data on outreach and emergency shelter populations. It also pays attention to 

research done elsewhere. Evidence of chronicity and extensive service use is driving the 

city's current shift of direction toward reducing emergency shelter beds, freezing 

transitional housing development, and concentrating on permanent supportive housing. 

(Contact person: Rob Hess, Deputy Managing Director, robert.hess@phila.gov.) 

In addition to these specific practices that may be of interest to other jurisdictions, several points 

about Philadelphia's approach to ending chronic homelessness are also important to note. First, 

people involved with homeless services, planning, and advocacy in Philadelphia have long 

histories in the city, in services, and with each other. There have been some extremely 

adversarial moments, but basically people have learned to work with each other, compromise, 

and move forward. Even potentially contentious situations such as the Sidewalk Behavior 

Ordinance have been turned to good advantage. 

Second, for at least the last decade, strong public support has been developed and sustained for 

helping homeless people and committing local resources to the task. This does not preclude 

occasional NIMBY responses to specific project locations, but even those issues have been 

handled with reasonable aplomb, especially since the city lost the 1515 Fairmount dispute. 

Finally, even with Philadelphia's history and local commitment, funding issues can still strike 

hard. The new state budget devastated the state's Human Service Development Fund (HSDF) 

and funding for social services and drug and alcohol treatment. It is not clear at this time whether 

fmal allocations will look as bad as they do at this writing (late spring 2003), but if they do it has 

the potential to really undermine homeless assistance in Philadelphia. 

Primary Contact Person 

Robert Hess 

Deputy Managing Director, Special Needs Housing 

Managing Director's Office-Adult Services 

1321 Arch Street, 51h Floor 

Philadelphia, PA 19107 

E-mail: robert.hess@phila.gov 

History and Context-How the Current System Evolved 

Two elements strike one as essential in explaining Philadelphia's activities related to 

homelessness-how long the key players have been involved, and how well they have learned to 

get along. These two elements have allowed Philadelphia to take advantage of situations and tum 

potentially hostile confrontations into opportunities for progress. 

E.3 
Appendix E: Philadelphia 

Many Philadelphia providers, advocates, and even government officials date their involvement in 

efforts to help homeless people from the late or even early 1970s. Further, most have occupied 

more than one role over the years or at the same time, moving from advocate to provider to 

government position and back again, O!: moving among providers and among types of programs 

as they develop. Mayors and key government officials have been activists themselves, or 

providers, or both. Drawing on a wealth of experiences and the contacts that the years provide, 

they have accommodated rather than feared tension among different interests, seeing it as a basic 

engine of progress. They have focused and planned for the long term and created structures and 

investments to make it happen, learned from experience, and refocused as new evidence has 

pointed toward the need to redirect resources and service structures. 

Mayoral Support and Public Leadership 

Philadelphia's programs to help street homeless people evolved from the beginning as a 

partnership between city government and providers. As the effects of mental hospital closures 

began to make themselves apparent with the appearance on the streets of people with serious 

mental illness, providers were the fIrst to respond, fIrst with street outreach and then with 

permanent supportive housing (PSH). Some of Philadelphia's PSH goes back to this era (Women 

of Hope opened in 1985 for mentally ill "bag ladies," and Bethesda Project opened three 

permanent supportive housing programs in 1983, 1986, and 1988). Even that early, 

Philadelphia's mental health agency was supporting specialized housing for formerly homeless 

people with mental illness. 

When the city decided that it had to respond to increasing homelessness, officials came to the 

providers to -ask what they should do. In January 1987, Mayor Goode, feeling pressure from 

homeless advocacy groups, media attention to shelter conditions, and lawsuits against the city, 

created the Mayor's PubliclPrivate Task Force on Homelessness, which included advocates, 

providers, business people, and city officials in its membership. This Task Force had the initial 

assignment of identifying roles for the city. It had the further assignment of monitoring city 

actions to see whether city agencies were living up to their commitments. The Task Force met 

regularly and agency heads reported their progress to all members, who could (and did) question, 

suggest, challenge, and otherwise fulfIll their monitoring role. 

One result of the Task Force was bureaucratic reorganization and a new mission. In 1988 Goode 

passed Executive Order 6-88 transforming what had been Adult Services and Aging into the 

OffIce of Service to the Homeless and Adults (OSHA). OSHA was mandated to "eliminate 

homelessness and other conditions that threaten survival through the assurance of access to 

housing, jobs, and other resources to enable families and individuals to attain the highest level of 

independence and self-suffIciency" (OffIce of Emergency Shelter and Services, 1997). OSHA 

put city resources into emergency shelter and established central intake and payment 

mechanisms. 

In 1992, Mayor Ed Rendell initiated strategies that included coordinating approaches, shifting 

the focus from emergency shelter to prevention, transitional housing and self sufficiency and 

getting additional Federal, state, and private support for homeless initiatives (City of 

Philadelphia, 1996). In 1996, OSHA became the OffIce of Emergency Shelter and Services 

E.4 
Appendix E: Philadelphia 

(OESS) under Rendell, a change in name that represented the city's attempt to coordinate all city 

homeless services. Tbe_OESS mission statement was changed to "provide comprehensive case 

management, support services, referrals to housing, emergency assistance to persons in need of 

shelter and other types of assistance in order to maintain or regain housing" (Office of 

Emergency Services, 1996). 

In 2000, the city created Adult Services (AS), so named to indicate responsibility for adult well­

-being and not just for homelessness. OESS and much of OHCD homeless-related work was 

brought under the Adult Services aegis. Adult Services now also includes the newly minted 

Housing Support Center (described below). 

Several mayors have supported strong city investment in social services and behavioral health 

services, and have appointed dynamic staff to make these services work. Respondents frequently 

mentioned the influence of Estelle Richman, who for at least ten years increased her breadth of 

control until she became the Deputy Managing Director for Social Services. She started the 

weekly meetings of department heads described below, and tracked plans and progress on many 

fronts. With particular relevance for homelessness, she pushed for the current configuration of 

BHS, including the creation of Community Behavioral Health (CBH), the city's own managed 

behavioral health care system. She also saw from the beginning that housing was part of the 

answer. Directors of Office of Mental Health (OMH) and Coordinating Office of Drug and 

Alcohol Abuse Programs (CODAAP), who ultimately answered to her, supported development 

of housing and service options that continue to play preventive roles in keeping more disabled 

people off the streets. Many city officials we interviewed considered themselves to be following 

Richman's example, "doing the right thing" first and handling bureaucratic consequences as they 

anse. 

On the housing side, John Kromer served as director ofOHCD from 1992 to 2001, thus also 

having ten years to pursue a long-term strategy of neighborhood reinvestment and serving as the 

first housing director to use OHCD resources to develop housing for homeless people (Kromer, 

2001). OHCD controlled Federal Emergency Shelter Grant (ESG) funds, which by design were 

used for homeless services. It also controlled other important Federal funding sources 

(Community Development Block Grant (CDBG), Housing Opportunities for Persons with AIDS 

(HOPW A), and HOME funds (a HUD block grant program)) that it used to increase housing 

options for homeless people. Where the social services side of city govenunent could and would 

supply the supportive services, Kromer committed OHCD to supply the housing. Philadelphia 

had underspent its CDBG allotment for a number of years, so when Kromer took office he had 

money available to support transitional and permanent housing development. Due to the 

intricacies of how CDBG money is allocated and accounted for, he was able to support most 

proposals that came to OHCD during the critical period in the early 1990s when demand for 

options other than emergency shelter were increasing. Philadelphia was thus able to develop an 

array ofPSH before major homeless-specific Federal funding was available through the 

McKinney-Vento Act. 

E.5 
Appendix E: Philadelphia 

Demonstration Program Participation 

The system of care currently available for ending street homelessness in Philadelphia has 

benefited from the city's participation in a number of national demonstration programs. It is also 

true that Philadelphia's early independent efforts to develop appropriate types of support for 

street homeless people put it in an excellent position to write winning proposals for these 

national demonstration programs. The city's continuous involvement in one or more 

demonstrations throughout the 1990s meant that one way or another, it was routinely and 

systematically attending to services and system integration and long-tenn planning for homeless 

people, and most particularly for those with serious mental illness. 

RWJ's Program on Chronic Mental Illness. In the late 1980s, the RO-bert Wood Johnson 

Foundation (RWJ) wanted to invest in a major national demonstration program to stimulate the 

development of community-based residential systems of care for people with serious mental 

illness. Foundation representatives came to Philadelphia to observe the residential settings that 

already existed for chronically homeless street people (Women of Hope, Bethesda Project sites), 

before designing its request for proposals from communities around the nation for its Program on 

Chronic Mental Illness. The RWJ demonstration, which functioned in the first half of the 1990s, 

combined foundation funding and HUD commitments of Section 8 vouchers to cover much of 

the rent for housing options, and required that the local public mental health agency commit its 

own resources to supportive services and case management. While not specifically designed to 

end or prevent homelessness, in effect the systems of services resulting from the RWJ effort did 

both for people with serious mental illness. 

As important as ending or preventing homelessness for specific individuals was the effect of the 

RWJ initiative on building organizational capacity for developing PSH. Philadelphia became one 

of nine communities to participate in the RWJ demonstration. A new CDC-the 1260 Housing 

Development Corporation-was developed in Philadelphia to create much of the housing 

(something that happened in several RWJ communities). OMH and several service providers 

gained considerable experience in developing PSH through this initiative, and the city gained a 

variety of new housing options with supportive services. 

The Cisneros "Initiative" Projects. Henry Cisneros, President Clinton's first HUD Secretary, 

took to heart the idea of a continuum of care for homeless people and committed Federal funds 

to stimulate cities to develop such a continuum. Washington, DC got the first of these 

"Initiative" grants in 1993; Philadelphia was one of four cities to receive the other grants. 

Philadelphia received $8 million over five years to mobilize the public and private agencies 

addressing homelessness, undertake systematic needs assessment and long-range planning, and 

use Initiative funds to fill out its continuum by increasing its range of options for transitional 

housing and PSH. When HUD made the concept of a continuum of care the centerpiece for its 

funding through the Supported Housing Program from 1996 onward, Philadelphia had already 

been working to expand its continuum for several years. It was thus in an excellent position to do 

very well in the new "Super Notice of Funds Availability" application process. Between 1992 

(before the Initiative) and 1997, Federal funding coming into Philadelphia for homeless-related 

services increased from $49 million to $70-71 million. 

E.6 
Appendix E: Philadelphia 

ACCESS. In the late 1 990s, the Center for Mental Health Services in the U.S. Department of 

Health and Human Services launched a demonstration program to see whetheLSystematic 

outreach with integrated mental health and other services could help bring homeless street people 

with serious mental illness off the streets and help them maintain housing. Philadelphia was one 

of nine demonstration sites, which, along with nine comparison sites in the same states, make up 

the Access to Community Care and Effective Services and Support (ACCESS) demonstration 

program. 

Turning Points and the Role ofAdvocacy-No Movement Without Tension 

Along with a number of other cities, advocacy stimulated Philadelphia to pass a right-to-shelter 

ordinance in the early 1980s. "Right" implied public provision; which at its peak in the early and 

mid-1980smeant that the city paid for around 5,000 people a night to occupy emergency shelter 

beds. This ordinance is still technically on the books, although it has undergone considerable 

reinterpretation with the acquiescence of advocates. The crack epidemic of the ruid-1980s 

changed the balance of the street homeless population from one with predominantly mental 

health or alcohol problems to one with a large proportion of crack abusers. CODAAP data 

indicate that the city had 79 clinical treatment admissions for crack cocaine in 1980, which rose 

to more than 10,000 in 1989. Debates about whether providing unlimited shelter was just 

facilitating addiction led in the late 1980s to the imposition of behavioral requirements and 

length of stay limits and had the effect of cutting the number of emergency shelter beds 

approximately in half, to about 2,300, only slightly more than the number that exists today. 

The Struggle for 1515 Fairmount 

In 1991, Project H.O.M.E (standing for Housing, Opportunity, Medical Care and Education) 

started to acquire the building at 1515 Fairmount Avenue and tum it into a PSH residence for 48 

formerly homeless people, a cafe, catering business, thrift shop, and headquarters offices for the 

organization. Stiff local opposition from politically well-cormected people, including the mayor, 

led to a four-year legal battle that eventually involved the U.S. Department of Justice and Federal 

courts. Local advocacy, call-in campaigns to the mayor, protest marches and arrests, offers along 

the way by Project H.O.M.E. to compromise over supervision of the building and its activities, 

all failed to resolve the issue out of court, although they kept issues related to disabled homeless 

people, PSH, and neighborhood relations in the forefront of the news. When the city lost and had 

to pay about $1 million in Project H.O.M.E. 's legal costs, legal efforts to block development of 

future projects were severely curtailed. 

The Sidewalk Behavior Ordinance 

In 1998 a City Council member introduced a bill to crinllnalize many of the behaviors and 

actions of homeless street people. The proposed legislation galvanized the homeless advocacy 

community and brought a great deal of pressure to bear on the Council. The city ordinance 

eventually passed, but by that time it had been changed in major ways and carried with it 

significant new funding to provide alternatives to street homelessness. 

E.7 
Appendix E: Philadelphia 

The response to the sidewalk behavior legislation was a remarkable example of what 

Philadelphia respondents mean by their assertion that problems can be resolved because "we all 

continue to talk with each other." Downtown businesses wanted to do something to decrease the 

odds that people corning downtown to shop, do business, attend conventions, or visit tourist 

attractions would encounter panhandlers or people living on the streets. Advocates countered 

with two tacks-}) arresting people would just add a crintinal record to their other clifficulties in 

leaving homelessness, and 2) if you want to get people off the streets, you have to offer some 

alternatives that they -are willing to take. After a good deal of controversy, the results were: 

• 	 An ordinance passed, and is still city law. 

• 	 Proscribed sidewalk behavior is not criminalized, however. Instead, police may issue a 

ticket similar to a parking ticket, and then only after making several attempts to offer 

shelter or other assistance themselves, calling an outreach worker, and having the 

individual refuse any type of assistance from the outreach worker. 

• 	 New services were authorized to provide alternatives to living on the street, and about $5 

million annually in new money was authorized to pay for them. The services include: 

~ The Outreach Coordinating Center (OCC), its management and oversight activities, 

and its outreach teams; 

~ Four new safe haven residences, comprising 85 new low/no demand beds for 

substance abusers, mentally ill individuals, and those with co-occurring disorders; and 

~ New commitments to PSH. 

~ The police department's Homeless Outreach Team, which had been around for 

several years, was instructed to work with OCC outreach and respond to street 

emergencIes. 

Even with this agreement, and new funds flowing into programs to help people move from the 

streets to housing, advocacy proved necessary to stop police harassment of homeless street 

people. Police had been giving homeless people citations for "obstructing the highway." 

Advocates set up observers and photographed incidents to show that the people arrested had not 

been obstructing the highway. Homeless people found "not guilty" filed a class action suit in 

Federal court claiming that they were being illegally arrested as a form of harassment. The case 

was settled out of court with no admission of guilt on the city/police's part, arrested people were 

given cash settlements, and the attorneys were given the oversight of all similar citations issued 

in Center City to make sure that this practice did not continue. At present, the "ticket" authorized 

by the ordinance is rarely issued and the police outreach team works well with teams from the 

OCe. 

E.8 
Appendix E: Philadelphia 

Approach to Chronic Street Homelessness 

This section briefly describes the network of programs and services focused on reducing or 

ending chronic street homeless ness among single adults. It also examines characteristics of 

Appendix A: Birmingham 

Table A.2: 


street counts 0 f B·Irmmglham Home ess popu ation 


Year of Survey Homeless Persons Street Homeless Persons 

1995 1,404 330 

2001 1,667 244 

2003 1,616 220 

In 2003 the number of street homeless persons (220) was 19 percent lower than in 1995. The 

2003 non-street homeless population counted 1,616, while below the numbers in 2001 , are 12 

percent higher than 1995. The survey also gathered information on characteristics of homeless 

individuals, such as age, sex, rac.e, ethnicity, family status, education, income, veterans, status, 

disabilities, health care, and homeless services being received. These characteristics data have 

not yet been released broken down separately for the street homeless population. 

Movement ofStreet Homeless into Housing 

The Cooperative Downtown Ministries has placed 189 persons into its transitional housing 

program since 2000, of whom about 80 percent were chronic street homeless individuals. Among 

those characterized by chronic homelessness, about 85 percent are substance abusers, 33 percent 

have a serious mental illness, and about 23 percent are dually diagnosed. 

The transitional housing program's capacity was 30 individuals, but has recently been expanded 

to 87. Of the 189 persons who have been in the program, 17 percent are still in the program, 49 

percent left for permanent housing, 19 percent have unknown whereabouts (most are thought to 

be in housing with family or friends) , 10 percent went to another program or jail, and 5 percent 

left the program for other reasons. 

The CDM opened its own PSH program only a few months ago, but has been placing people 

from its transitional housing program into other PSH programs. Many others have been directly 

connected to other permanent housing programs by CDM's case manager without going through 

CDM's transitional housing program. Of the 75 who went from its transitional housing program 

to a permanent supportive housing program, 47 percent have remained at least 24 months, 21 

percent at least 18 months, 13 percent at least 12 months and 19 percent less than 12 months. 

Public Funding 

Birmingham does not have any special local or state funding of programs to reduce chronic street 

homelessness, which may be why it has developed private funding more than the other sites 

visited. Table A.3 indicates the local agencies providing funds or staff, and the sources of their 

fllnnino 
Appendix E: Philadelphia 

Progressive Demand Residences (PDRs), which function much like safe havens. Some providers 

(for example, One Day at a Time) specialize in working with substance abusers. 

Involvement ofMainstream Agencies 

As a conscious part of Philadelphia's approach to ending chronic street homelessness, many city 

agencies are involved in the homeless assistance system serving this population. Most use their 

resources to fund homeless assistance programs or supportive services and case management; 

many also offer some programs and services with their own staff (see Table E.l). All participate 

in one or more of the coordination mechanisms described below. 

Shelter and Housing. Homeless assistance programs fall primarily under the responsibility of 

OHCD and Adult Services. OHCD receives ESG, CDBG, HOPWA, and other Federal resources, 

and conducts the annual Consolidated Plan process. It transfers Federal resources to AS for 

funding emergency shelter and additional transitional housing. City, state (Homeless Assistance 

Program), and Federal funds flow through Adult Services and its component parts, the OESS, the 

newly created Housing Support Center (HSC), Riverview Home (a city-owned personal care 

residence for elderly and/or vulnerable Philadelphians) and the Office ofHIV Planning (a body 

responsible for coordinated planning for Federal funding from the Centers for Disease Control 

and Ryan White Title I). AS is also the city's convener for the annual Continuum of Care 

application. Some other agencies-OMB, CODAAP, and the Department of Human Services 

(DHS), (the child welfare office)-maintain small numbers of units that are closer to "housing 

plus services" than to treatment, and that accept homeless people as residents. 

OESS maintains two central intake systems, one for single men and one for women with or 

without accompanying children. When the city decided to do central intake, around 1989, it did 

so to assure that regardless of individual problems, people received shelter beds, and to increase 

the efficiency of shelter use. Emergency shelter occupancy went from about 80 percent to 97 

percent once the central intake system was fully operational. 

While it does not run any shelters or transitional programs itself, the city pays for shelter for all 

people that OESS places into emergency or transitional programs. The intake databases link to a 

management information system that can provide an unduplicated count and other information 

about people served, going back to 1989. At present the city pays for about 2,100 shelter beds a 

night, comprising about 80 percent of the city's emergency shelter capacity. This number is 

d.own about 10 percent from 2001, in a deliberate effort to switch occupancy from emergency to 

permanent supportive housing for chronic shelter users. These OESS shelters served about 

10,000 different single adults and 14,000 adults and children in families from November 2001 

through October 2002 (unduplicated counts). 

E.lO 
Appendix E: Philadelphia 

Table E.1: City of Philadelphia: Agencies Involved in Reducing/Ending Chronic Street Homelessness 

Homeless-Related and Services 

f' cf 

S § l 8' 

-SO) 0 

t:: 0 t:: iii..... h t'b t::.!::J ::: t::", 

If,tf !/:sq; Go 

! ! l. JIIIlijj/llllll/A1

Q.' 0" Cf 0'" P Q.":t ! 0' J f ;f t l ;; :f f Q.'" i is .$' :l.8 cJ : (j i rJfc; c§' t! t 

Nonprofit Programsl Servlcesl Agencies Serving Currently or Formerly Chronic Street Homeless People (lIsted 

alphabetically) 

1260 Housing Devel. Corp (housing devellmgmt) X X X 

Asoci asion de Puertorriquenos en Ma rch a (APM) X X X X X X 

Bethesda Project X X X X X X X X X X X 

night shelter (280 beds , primary route to TH and PSH) X X X X X 


Transitional Housing 36 units in two sites X X X X X 


PSHlind Lvg 106 units in several sites X X X X X 


Catholic Social Services X X X X X 

SI. John's Hospice (men) X X X X X X 

McAuley House (women) X X X X 

Wo men ot Hope X X X X 

Dignity X X X X X X X 

Horizon House X X X X X X X X X X E 

Engagement Center at Arch 51. United Melh C hurch X X X 

Street outreach, outreach X X X 

Transition al Treatment Program X X X X 

Shelter + Care (several sites) X X X X X X 

Mental Health Association X X X X X X E 

West Philadelphia Access X X X X 

One Day at a Time several sites X X X X X 

Philadelphia Committee to End Homelessness X X X X E 

Phila Health Management Corporation X X X X X X X 

Project H.O.M.E. X X X X X X X X X X X X X E 

Outreach Coordinating Center (OCC) X X X E 

Sate Havens (50 units in Iwo sites) X X X X X 

Transitional Housing (62 units In two sites) X X X X X 

PSH (121 unils in several sites) X X X X X X X Home Ownership/Economic Development X 


Resources lor Human Development (RHD) X X X X X X X E 

Ridge Ave ShelterlFirst Step/Connection 51TH X X X X X X X X X 

Kailo Haven X X X X X 

Always Have a Dream X X X X X 

PSHlvarious disabilIties and combinations X X X X X X Home Ownership/Economic Development X 

Salvation Army/Eliza Shirley Housellvy Bridge X X X X X X X X X SELF , Inc. X X X X X X 

Women's Community Revitalization Project X X X X X X E 

Other Providers 

Hall Mer cer CMHC JX I X I X I X I 


Philadelphia Veterans Multi·Service & Ed Clr I X I I I I I I I I I I I I 

VA Medical Center Outreach Team 


I I I I I I I 

I X I I I I I I I I I I I 

X = Provider E = Expert TA Provider F = Funder 

E.11 
Ready, Willing, and Able 


Phila . Workforce Development Corp (PWDC) 


Prof. Healthcare Institule (E& T) 


Awbury Arboretum (E&T) 


Related Activities and Advocacy 

Center City Business District 

Corp for Supportive Housing (CSH) 

Blueprint to End Homelessness 

Pennsylvania Low Income Housing Coalition 

Homeless Advocacy Project 

Kensington Welfare Rights Unioin 

Regional Legal Housing Services 

Tenants Action Group 

Energy Coordinating Agency University of Pennsylvania 

Government Programs/Services! Agencies Serving 

Currently or Formerly Chronic Street HomelesS PeOjlle 

Dffice of the Mayor 

Mayor's Task Force on Homelessness 

Office of Adult Services (OAS) 

Housing Support Center 

Office of Emergency Shelter and Services (0 ESS) 

Pennsylvania Dept. of Public Welfare, Homeless 

Assistance Program (HAP). through OAS 

Office of Hsg and Cmty Dev (OHCD)/Hsg Neigh Pres 

Philadelphia Housing 

Redevelopment Authority 

Dept of Community and Economic Dev (DC ED) Department of Public Health (DPH) 

Behavioral Health System (BHS) 

Community Behavioral Health (CBH) 
Coord Off of DAA Progs (CODAAP/BHS) 


Office of Mental Health (OM H) 


Access to Alternative Services 

Dept of Human Services (DHS) Philadelphia County Assistance Office Philadelphia Police Department 

x = Provider 

Appendix E: Philadelphia 

Table E.1: (Continued) 

"t;>i '- t 

.1' 	 ,g> t' cf 0'" 	 ,s 0 o .s; .. t 	 f ()o "" IS: s §. '" .C:- 0 	 [ G-i 

,.r§" .. 1:> c:- <?' 
 '" c:- '< G­

§ " c:- c: 	 JP ' ., c:- '" 6' t! (.j .. :§ S- '" ! 	 ,J :! !!! .1' :1? # 	 ,g o!!' ",0 $ t "/j,g> § O! .. /' '" 0 r§" f t? fj;1J :;s .-$' Q./!' o 0'" ,,::'" Q." is ;1 :! lIJ Q.'" (f ()'" ()e o? I 


x x x x 


X, F 	 x x 


x 


x 


x 	 X x x 

E E 


X x x E X x x 


X 
X X 


X 


X 


E 

X X 

X X E X X 

F lX, FIX, FI F F F F F F X X 

F I I F F 	 F 


F F F F X X 


F F X X 


X, F X X 


F I I F X 


X, FIX, F X, FIX, FIX, F X X E 


X, FIX, F X, FIX, F X X X E 
X, FIX, F X, FIX, F X X 


X, FIX,F X,F X,F x X E 


X, FIX, F F X, F X,F X X E 


X X X, F X,F X X 


X,F F X X X 


X X X 


x X X 


E = Expert TA Provider 	 F = Fund

E.l2 
Appendix E: Philadelphia 

approximately 30 percent have a chronic substance use disorder, and approximately 30 percent 

are dually-diagnosed with serious mental illness and chronic substance use disorder. 

Central intake mechanisms, an up-to-date inventory of available shelter beds, and a sheltertracking database provide further coordination for system entry, if the system being entered is 

emergency shelter. At present, units in safe havens, some transitional housing, and most 

permanent supportive housing are outside of this database. Future plans for a homeless 

management information system include bringing these units into the database, however they are 

funded. However, just because the current database does not account for some resources does not 

mean that they are outside a system of coordination through Adult Services. For instance, the 

PHA makes some Section 8 "Good Neighbor" vouchers available for permanent supportive 

housing. Adult Services manages referrals to PHA, packages the Section 8 applications, and 

shares a database with PHA that indicates the status of each individual who has been referred. 

Adult Services considers these vouchers to be "inside" its system, even though they are not, as 

yet, included in one overarching database. 

Specialized services. Philadelphia has a history of reorganizing its city agencies to improve 

performance and efficiency in addressing homelessness as well as other issues. Coordinating 

entities affecting homelessness include the Adult Services and the Behavioral Health System. 

Within the Behavioral Health System, OMH and CODAAP both support continuums of care, 

including residential care, for qualifying individuals, and have mechanisms for qualifying 

chronically homeless street people through arrangements with outreachllnd other programs. 

Interdepartmental coordination. Heads of agencies under the aegis of the Deputy Managing 

Director for Social Services meet weekly to review activities, develop and monitor plans, handle 

bottlenecks, and work together on cross-agency issues. These agencies include all of the "usual" 

types of social services plus agencies responsible for prisons, aging, disabilities, recreation, and 

mural arts. Ending chronic street homelessness is only one of the many issues these meetings 

address, but when interagency barriers impede progress toward this goal, these meetings are the 

forum for developing solutions. When these meetings started in 1999, most agency heads did not 

have a history or inclination to identify ways they could help each other. They had to "get to 

know each other and learn to play together," in the words of several respondents who 

participated in early meetings. These meetings still serve an important coordinating function at 

the agency-to-agency level. 

A second interdepartmental coordinating mechanism is the monthly meeting the current mayor 

holds with social services managers and directors. The mayor never misses these meetings, 

which he uses to learn how plans are progressing, whether problems are being resolved, and 

other issues. Both the weekly and monthly meetings of agency heads offer opportunities to 

develop cross-departmental working relationships. Issues related to homelessness and homeless 

programs and services arise regularly at these meetings, where the first steps toward resolution 

can occur. 

For the future, the city is implementing an Integrated Data Information System (lDIS), a 

computer program that brings together all client-related data from the city's social service 

agencies. Agency staff working with clients, and data analysts, will be able to log into the 

program to find out what services are being provided to clients, and by which agencies. The 

E.15 
Appendix E: Philadelphia 

homeless management information system will link into this IDIS, allowing the city to detennine 

where intervention might have prevented homelessness, which city resources are most used by 

homeless people, and where clients who have left one part of the system may have appeared in 

another part. 

Citywide coordination andplanning. Three citywide coordination and planning mechanisms 

exist, with many of the same individuals involved in two or all three. Two address chronic street 

homelessness in the context of all homelessness; the third focuses specifically on chronic street 

homelessness. The first, now organized by AS, is the annual process for developing the 

Continuum of Care application to HUD. The second is the committee structure of the Blueprint 

to End Homelessness, orchestrated by the Greater Philadelphia Urban Affairs Coalition. The 

Blueprint itself was published in 1998. Committees (for example, Shelter and Services, Housing, 

Employment, Housing Trust Fund) meet monthly to report back on their progress in 

implementing various Blueprint objectives, to share concerns, and to alert members to upcoming 

issues and events. Reports to the Blueprint's Implementation Committee include one from the 

third citywide coordinating entity, the Mayor's Task Force on Homelessness. 

John F. Street, the current mayor, established the Mayor's Task Force on Homelessness even 

before he took office. It is one of several responses to the introduction and ultimate passage in 

1998 of the Sidewalk Behavior Ordinance. With almost 70 members representing every possible 

interested party, the Task Force addresses issues related to street homelessness, especially in the 

center city area. These issues include outreach, access to shelter resources, police/community/ 

homeless person relations, differentiating between panhandling and homelessness, running 

public education campaigns, services delivered "on the street," and similar issues. Members 

include representatives from the city council, businesses, faith communities, neighborhood and 

civic associations, homeless services providers, relevant government agencies, the Chamber of 

Commerce, legal and housing advocates, universities, the Convention Center and Visitors 

Bureau, the Center City [Business Improvement] District, and private foundations. 

Pathways to Housing, Approaches and Models 

Philadelphia's homeless assistance network has historically been organized on the assumption 

that people will move through steps or stages. However, transitional housing and even 

emergency shelter is not always one of the steps for single disabled adults who have been 

chronically homeless and on the streets. Outreach and service workers interviewed (at least 20 

people from many organizations) reported that there are no one or two "typical" pathways from 

the streets to permanent housing, as accommodations can be and are made depending on 

individual needs. Nevertheless, we can try to typify the more usual routes. 

• 	 Outreach to safe haven to hOUSing, or outreach directly to housing. One of the goals of 

the OCC is to help chronically street homeless people bypass the emergency shelter 

system altogether and enter directly into housing. The housing may be a safe haven 

(Philadelphia has four safe havens connected to the OCC, and several other no-demand 

small residential settings for people with disabilities). If the person has a severe and 

persistent mental illness, the housing could be anyone of several residential settings paid 

for by OMH through contracts with providers. CODAAP also maintains some residential 

E.16 
Appendix E: Philadelphia 

slots for substance abusers. There are also a few residential settings for people living with 

HIV/ AIDS, with or without other conditions. 

• 	 Outreach to emergency shelter to trcmsitional housing to "regular" housing. This is a 

more common progression for substance abusers who are not also mentally ill. This is a 

"dry" route, meaning that each step after outreach requires the person to be clean and 

sober-with strong support offered to help people recover from relapses. If people 

cannot or will not refrain from using drugs or alcohol, they are more likely to follow the 

safe haven/no demand route, which includes various forms of "damp" and "wet" 

housing. 

Philadelphia is just starting its first program based on a pure "HoUSL.'lg First" approach, 

bypassing even the safe haven stage of moving from street to housing. Research evidence on 

housing fIrst models has convinced officials that this is an important model to try. Further, 

analyses by Dennis Culhane and colleagues from the University of Pennsylvania of data from 

Philadelphia's own shelter tracking database reveal the large numbers of chronically homeless 

people who, in effect, make their home in the system, or going between the system and the 

streets. In Philadelphia as elsewhere, 10-15 percent of shelter users are absorbing half or more of 

shelter resources, at signifIcant public expense. The idea that these people could be moved to 

housing and helped to maintain it through supportive services is appealing, in that it would help 

people leave the streets and save emergency shelter resources for true emergencies. 

Documenting Success 

Philadelphia has been tracking its progress through street counts of the homeless and by the 

success of programs in moving homeless individuals into housing. 

Street Counts 

Police have conducted monthly or bi-monthly street counts in the center city area since the mid1990s. Since 1998, outreach workers coordinated through the OCC have conducted quarterly 

street counts over a broader area that includes all of downtown and west and southwest 

Philadelphia. The peak police street count of 824 occurred in June 1997. Earlier police street 

counts for center city had fluctuated between winter lows below 200 and highs around 300 

(Greater Philadelphia Urban Affairs Coalition, 1998). 

Street counts conducted by the OCC between 1998 and the present show the effects of concerted 

efforts to develop alternatives to the streets for chronically homeless people with disabilities, 

including safe havens and permanent supportive housing. Summer counts went from 395 in 1998 

to 320 in 1999 and 228 and 240 in 2000 and 2001, respectively.32 August 2002 witnessed an 

increase to 356 and in August 2003 the count rose to 370, as street homelessness reflects the poor 

economic conditions of the larger society. February fIgures are considerably lower, as 

32 	 These and the following statistics are taken from Year 29 Preliminary Consolidated Plan (FY 2004), page 25, 

http://www.phila.gov/ohcdlcconplan.htm. 

E.l7 
Appendix E: Philadelphia 

Philadelphia increases outreach efforts and expands access to emergency shelter beds on winter 

days when the temperature falls too low for safety. Figures for February 1999,2000, and 2001 

vary little, from 167 to 172. However, the count for February 2002 was higher, at 235, mirroring 

the summer increases for the most recent year. Temperatures in the 30s and 17 inches of snow on 

the ground reduced the street count to 32 in February of2003. 

Movement ofStreet Homeless into Housing 

Permanent supportive housing is one avenue that may help chronically homeless people with 

disabilities move off the streets and into stable housing-. We asked the major PSH providers if 

they had data that could document whether residents of their PSH units had been chronically 

homeless and whether they had achieved housing stability in PSH programs. Two providers, 

Project H.O.M.E. and RHD, were able to provide relevant data. 

Project H.O.M.E. provided data about residents in the two safe haven programs and two 

transitional residences (with 80 beds) that are coordinated through oee, and about residents in 

its five PSH projects (with 121 units) for single adults. Since July 1,1999, the safe havens have 

served 539 clients. All safe haven residents are either mentally ill, substance abusers, or both, as 

well as being likely to have physical health and other problems. Data on 1eng-th of homelessness 

before entering a safe haven are available for 160 people, of whom 47 percent had been 

homeless for longer than one year, with 32 percent being homeless for two years or more. 

Among the 399 people for whom previous living situation is known, 30 percent came from the 

streets and other non-housing locations, 17 percent came directly from mental health or 

substance abuse treatment facilities, and 36 percent came from emergency shelters or a different 

safe haven. Among the 537 people whose length of stay at a safe haven is known, 52 percent 

stayed for six months or less, and 30 percent stayed for more than one year, with an average 

length of stay of 1.3 years. Information about current living situation is available for 516 people, 

of whom 23 percent still live at the safe haven, 36 percent moved to better housing situations (for 

example, PSH, own housing, with family), 2.5 percent died; 22 percent left for situations that 

were similar or less desirable, and current whereabouts could not be ascertained for 18 percent. 

Project H.O.M.E.'s PSH programs have served 187 people since July 1, 1999. Among the 122 

people for whom length of previous homelessness is known, 67 percent had been homeless for 

one year or more, with 44 percent of these experiencing homeless spells of at least two years. 

Length of stay in PSH is available for all 187, among whom: 

• 136 (73 percent) stayed for at least 1 year; 

• 93 (50 percent) stayed for at least 2 years; 

• 51 (27 percent) stayed less than one year; and 

• Average length of stay is 3.2 years. 

Of the 90 people who left Project H.O.M.E.'s PSH, current whereabouts are known for 86 

percent. Of these, only 13 percent are living in situations that would be considered homeless, 

including on the streets, in emergency shelters, safe havens, or transitional housing programs. 

The rest are in a variety of stable housing situations. 

E.18 
Appendix E: Philadelphia 

RHD has served 121 consumers since 1995 in its Supported Adult Living Team program and 

another 25 (since 1989) in its Boulevard Apartments. RHD provides supportive services to 

seriously mentally ill people living in scattered-site residential units or multi-unit building rentsubsidized apartments. Of these 146 consumers, 45 came directly from homelessness. Most of 

the, remainder, all in the Supported Adult Living program, had significant periods of 

homelessness although their immediately prior residence was various transitional housing 

situations. Of these 146 individuals, 72 percent stayed for one year or more, including: 

• 61 (42 percent) who stayed for at least 2 years; 

• 23 (16 percent) who stayed for at least 18 months but less than 2 years; and 

• 21 (14 percent) who stayed for at least 12 but less than 18 months. 

Selected System Components 

Prevention 

Philadelphia funds a variety of programs to prevent homelessness, including budget and housing 

counseling, rent/mortgage/utility assistance, employment assistance, security deposits, and small 

loans. Most programs focus on preventing crisis rather than chronic street homelessness, and on 

families rather than singles. Residential program opportunities through OMH and CODAAP, 

described below under safe havens and no/low demand residences, offer the most meaningful 

prevention resources for people who have been or might become chronically homeless street 

people. 

Outreach and Drop-In 

The OCC's coordination of five teams' outreach activities has already been described. Some of 

the primary outreach teams are generalists while others specialize in either mental health or 

substance abuse issues. The primary outreach teams have access to specialized backup that will 

respond in the event someone they are working with has a health, mental health, or substance 

abuse crisis. In addition to the outreach teams operating through OCC, quite a number of other 

agencies in Philadelphia conduct street outreach, as reference to Table E.1 indicates several 

drop-in centers also serve as contact points for chronic street homeless people, including that of 

the Philadelphia Committee to End Homeiessness, the Engagement Center at Arch Street United 

Methodist Church (in conjunction with Horizon House), and the Philadelphia Veterans MultiService and Education Center. A high proportion of the people the drop-in centers attract are 

substance abusers. 

Outreach in Philadelphia operates mostly during the day and evening hours, with an on-call night 

outreach capacity accessed through Horizon House. Outreach used to be mostly at night, but 

workers found that the most they could do for people at night was offer them transportation to a 

shelter. During the daytime outreach workers can help people connect to a wide variety of 

benefits and services, which they have found is more effective in keeping people off the streets 

once they make the decision to accept help. 

E.l9 
Appendix E: Philadelphia 

Outreach teams help street-homeless consumers access public benefits (cash assistance, food 

stamps, medical assistance), health care (including dental and eye care), detoxification and other 

substance abuse treatment, safe havens and other low demand residences, medications and other 

mental health treatment, and the basics (food, clothing, blankets, showers, laundry facilities,. and 

so on). Outreach not linked through the OCC includes teams operating from the Center City 

District (a Business Improvement District) and the Philadelphia Police Department, which 

maintains a Homeless Service Detail whose officers call the OCC when they encounter a 

homeless person who needs assistance. Since 1998, the OCC has maintained a database of all 

persons contacted by the participating outreach teams. Through common identifiers, this 

database can be linked with the OESS database that chronicles most emergency shelter and some 

transitional housing stays. 

Safe Havens and Low Demand Residences 

Part of the compromise that led to passage of the Sidewalk Behavior Ordinance was commitment 

to creating low demand residences or safe havens. Under the aegis of the OCC, two agencies run 

the safe havens and transitional residences developed as a result. These include one with 25 beds 

for men and women with co-occurring mental health and substance use disorders, one with 25 

beds for substance-using men, one with 15 beds for substance-using women, and one with 20 

beds for mentally ill women with minimal substance use. The typical route into these safe havens 

is through contact with outreach. 

In addition to these safe havens, Philadelphia agencies offer several other low demand residential 

programs serving chronically homeless people with disabilities. These include several that are 

specifically for homeless people but were operating before the Sidewalk Ordinance. They also 

include the array of progressive demand residences supported by OMH that are available to 

severely mentally ill individuals whether they enter from homelessness, institutions, or other 

venues. 

Emergency Shelters 

Although Philadelphia does a lot to help chronically homeless street people with disabilities 

bypass emergency shelters in favor of safe havens and other low demand facilities, it does 

provide almost 900 beds of emergency shelter for singles, through 24 facilities operated by 18 

agencies, not counting overflow beds during cold weather. The city has deliberately been 

reducing the amount of emergency shelter it supports, down about 10 percent in 2002 from 2001 

as it switches to more safe havens and PSH for chronically homeless people. Placement into 

these facilities is through central intake for singles, and payment comes from the city. Analyses 

of the management information system attached to central intake indicates that about six times as 

many singles pass through the shelter system in a year's time as are present on any particular 

night. Further, chronicity occurs in emergency shelter as well as on the streets, with about 10 

percent of sheltered singles using 180 or more days of emergency shelter a year and absorbing 

about three times the number of shelter nights as their proportion in the population (Culhane et 

aI., 1994). Many of these same individuals probably sleep on the streets during the nights they 

E.20 
Appendix E: Philadelphia 

are not in shelter-thus reducing chronic street home1essness is also likely to reduce demand for 

shelter beds. 

Transitional Programs 

Philadelphia has close to 1,900 transitional housing slots for singles, including almost 400 beds 

in residential programs supported by OMH and CODAAP that offer transitional living situations. 

All of the large homeless service providers addressing the needs-of street homeless people offer 

one or more options for transitional housing, most of which focus on the needs of substance 

abusers. Most are shorter than two years, although people can stay that long in some of them. 

Most have graduated steps or mechanisms for affording increasing privileges or desirable living 

situations to people -as they gain greater time and confidence in their sobriety. These steps 

include leadership positions, greater privacy, and greater autonomy to control one's daily 

schedule. Many have an emphasis on employment and building up to the ability to get and hold a 

job, including finishing a G.E.D., learning computer skills, developing a resume, gaining 

interviewing experience, and other typical job readiness activities. Often the same provider 

organizations operate several programs, some of which are purely "homeless" in the origins of 

their residents while some focus more exclusively on people with similar disabilities who have 

not (or have not recently) been homeless. Philadelphia is not supporting development of any 

more transitional housing units, as its emphasis has shifted to permanent supportive housing. 

Permanent Supportive Housing 

Philadelphia's 2003 CoC application lists about 1,300 PSH units for singles, in 30 programs run 

by 11 agencies. OMH is one of these agencies, responsible for 138 units of PSH. Not all of these 

units are occupied by people who once were chronically homeless street people, but many are. 

Another 90 units are in the pipeline from 2002 CoC funding. Clients access most of this PSH 

from emergency shelter, safe havens, or transitional housing programs. Until very recently 

Philadelphia did not have any programs that followed a "housing first" model, unless one wants 

to consider safe havens as pretty close to that approach, but with a time limit. However, research 

evidence has convinced homeless services planners that they ought to consider housing first as 

an option, and the fust such program was just getting under way at the time of our site visit. 

Very early on (pre-McKinney), Philadelphia had already made significant investments in PSH, 

and helped develop the model through its involvement with the Robert Wood Johnson 

Foundation program in the early 1990s. This is not surprising given the city's long-standing 

concern for helping chronically homeless people to leave the streets. Expanding PSH is the top 

priority of homeless assistance planners in Philadelphia, whether of the housing fust or the more 

traditional approach. 

Supportive Services 

In addition to the many supportive services that city agencies supply or purchase under contract 

to help maintain formerly homeless people in housing (described above, "Involvement of 

Mainstream Agencies"), housing providers and other agencies offer additional supports. The 

E.21 
Appendix E: Philadelphia 

Philadelphia Health Management Corporation (PHMC) runs a clinic, outreach, and other health 

services funded by Health Care for the Homeless and city dollars, and also provides case 

management and some job readiness and training activities. Several other agencies provide 

education and employment-related services, and many housing providers also offer employmentrelated services, computer labs for job readiness and training activities, and actual employment 

opportunities as staff, caterers, shop operators, renovation/construction workers, and other jobs. 

The Center City District has made a point of hiring formerly street homeless people, as part of its 

commitment to "put its money where its mouth is" to end street homelessness in center city. 

Affordable Housing 

Due to Philadelphia's long economic slide during the 1970s and 1980s and continued (if slowed) 

population loss, many long-term vacant and abandoned housing units exist in the city. While 

these units appear to offer the opportunity for developing affordable housing; compared to many 

other cities, significant public resources (an average of $75,000-$100,000 per house) are needed 

to subsidize the cost of new construction and rehabilitation. Compared to the incomes of 

Philadelphia's many poor households, houses at this price are still out of reach. The city's 2003 

housing budget of $213 million drew funding from CDBO, Section 108, HOPW A, HOME, the 

State of Pennsylvania, local bond funding for the mayor's Neighborhood Transformation 

Initiative (NTI), and other sources. Eight percent (about $17 million) of the budget is earmarked 

for affordable housing production. 

The NTI is Mayor Street's plan to preserve and rebuild Philadelphia neighborhoods by removing 

blighting conditions, creating opportunities for redevelopment and investment, and improving 

the delivery of city services and resources to neighborhoods. Creating 3,500 new units of 

affordable housing is one ofNTI's objectives. Homeless advocates are concerned about 

homeless people's access to these units, because the affordability criterion has been set for 

households with incomes of around $32,000 (50 percent of area median income), not for the 

incomes of most homeless or formerly homeless people, or even of the poorest households (those 

with incomes below $20,000, or 25-30 percent of area median income) (Hiller and Culhane, 

2003). In support of NT I, Adult Services and a broad-based Implementation Committee engaged 

the Corporation for Supportive Housing to help develop a five-year housing development 

agenda. The agenda proposes 3,400 units of new supportive housing by 2006, 1,500 of which are 

suggested to be part of NTI. 

After our visit, at the urging of the Philadelphia Affordable Housing Coalition, the Philadelphia 

City Council authorized an additional $10 million in new money for the city's 2003-2004 

OHCDINTI budget that will be earmarked for affordable housing. The $10 million will be 

distributed as $2.5 million to the Neighborhood-Based Rental Production program, which will 

help fmance an additional 100 units of affordable housing; $5 million to the Basic Systems 

Repair Program, which will repair and preserve at least 1,000 homes for low-income owneroccupants, and $2.5 million to make 175 homes wheelchair accessible for disabled individuals. 

To create more housing affordable to the very lowest income households, several of 

Philadelphia's large homeless assistance providers have also become housing developers. As 

CDCs, they create or renovate housing for households with incomes below $20,000, most of 

E.22 
Appendix E: Philadelphia 

whom will not have been literally homeless before occupying the units. NT! bond proceeds are 

being used to fmance the acquisition of vacant properties, some of which may become available 

to these CDCs at nominal cost. Because these developers also create training, employment, and 

recreation opportunities in the neighborhoods they develop, which they have selected because 

they are the neighborhoods that generate the most homelessness, they contribute to homelessness 

prevention as part of neighborhood revitalization. 

Public Funding 

Many Philadelphia public agencies support the city's efforts to move chronically homeless street 

people into pennanent housing situations. They do this through direct funding of homeless 

assistance providers and/or committing public agency staff to supply supportive services, and 

covering housing (as opposed to supportive services) costs through several mechanisms. Table 

E.2 shows the departments involved, the types of fInancial investments they make in ending 

street homelessness, and which Federal and state resources they control that are being used for 

homeless-related activities. 

Philadelphia's CBH also provides a unique source of public funding for homeless services. CBH 

is a city-operated managed behavioral health care organization. Part of its structure to insurers, 

including Medicaid, that help pay for services is a "profIt" margin. As a city agency, CBH is 

committed to investing a part of this "profIt" margin into homeless assistance services such as 

outreach that are not reimbursable on a fee-for-services basis, and in housing. 

Maintaining and Enhancing the System 

As detailed in our description of Philadelphia's mechanisms for coordinating homeless 

assistance, responsibility for maintaining and enhancing the system has a number of centers. In 

2000, under the leadership of Estelle Richman, Philadelphia created Adult Services and brought 

under its rubric OESS and many of the homelessness prevention and funding responsibilities that 

had been located in OHCD. The "homeless czar" position was created to increase access to 

mainstream resources for people who experience homelessness. Responsibility for organizing 

and submitting the city's annual Continuum of Care application to HUD has been transferred to 

Adult Services, and responsibility for overseeing the system on a day-to-day basis and for 

implementing long-range plans rests with Adult Services. Adult Services is supported in these 

responsibilities by the work of the Blueprint Implementation Committee and the Mayor's Task 

Force on Homelessness. City offIcials, providers, and advocates work closely together in all of 

these efforts, but providers and advocates may also challenge decisions or plans if they believe 

that some overall goal is not being well served. 

E.23 
- - -------------------------------------------------------------------------------------------

Appendix E: Philadelphia 

T bl E 2 L IA• t tiE d" • St eet H melessness 

- _ 'I 

- - - • I 1_:' 

Adult Services (AS) - ESG,_state HAP, HSDF* X X X 


Office of Mental Health (OMH) - MHBG, PATH X X X 


Coordinating Office of Drug and Alcohol Abuse 
 X X X Programs (CODAAP) - SABG 

Community Behavioral Health (CBH) X Soon X reinvesting "profits" 

Department of Public Health (DPH) X X 

Department of Human Serv{ces - T ANF, child X-direct and $ X-for chronically X welfare transferred to AS homeless families 


Philadelphia Workforce Development Corporation 


(PWDC-nonprofit agency responsible for X 


Workforce Investment Act funds) 


Philadelphia Health Management Corporation 
 X (PHMC-nonprofit agency) 


Office of Housing and Community Development X-direct and $ X-direct and through $ 
 X (OHCD)-SHELTERPLUSCARE transferred to AS transferred to AS 

X-acquires and develops X Redevelopment Authority properties 


Philadelphia Housing Authority - SRO Mod X-$ transferred X-case management 
 X-rent subsidies Rehab+Section 8 to AS support for Good Neighbors 

Mayor's Office of Community Services-SSBG X 

Philadelphia Police Department X-outreach 

Department of Recreation X-temp shelter in winter 

Licensing and Inspection X-assure building safety 

Public Property and Cooperative Programs X X 

Bond funds X X 

Department of Veterans Affairs X X 

* State resources-HAP = Homeless Assistance Program, which has been cut 10% for the 2003-2004 fiscal year; HSDF = Human Services Development Funds, 


which have been paying for drug treatment of uninsured people and for OESS case managers and programs, but which have been completely eliminated in the 


2003-2004 state budget. 


Developing or Adapting New Approaches 

Philadelphia's history in the homeless arena attests to its willingness and ability to entertain new 

ways of doing things when the situation warrants. Over the years the city has thoroughly changed 

its approach to outreach (from night to day, and much-increased coordination), and developed 

targeted responses to street homelessness in its low demand programs. As noted earlier, it began 

developing PSH in the early 1980s, long before McKinney funds became available for this 

purpose. 

These developments grew out of continuing dialogue among all the players about what was 

working and not working, and what was needed that was not available. Knowledge has played a 

significant role in many of these developments. For instance, in the early 1980s outreach teams 

identified 86 women living on the streets with mental illness who were afraid to use shelters. 

OMH became convinced that these women would benefit from a permanent supportive housing 

program (a concept that had not been fully formulated at that time), and invested in Women of 

Hope. U1timately, all of these women were assisted to leave the streets and obtained permanent 

housing, often at Women of Hope. 

E.24 
Appendix E: Philadelphia 

The city is just beginning to invest in the "housing first" approach to permanent supportive 

housing. Factors influencing this decision are the research evidence from housing fust 

demonstrations (most notably the New YorklNew York Initiative), plus analyses of the city's 

own data from OCC and OESS shelter databases. These sources document the number of chronic 

shelter users and street homeless people who would be appropriate for a housing fust approach. 

The Adult Services Deputy Managing Director meets monthly with researchers who know both 

the city's data and the broader field of homeless services research, to discuss implications for 

what Philadelphia should be doing next. 

Budget Cuts 

No matter how forward-looking and devoted a community is to supporting homeless-related 

programming, its opportunities rely on funding from many sources. Philadelphia, along with 

some of the other communities visited for this study, is facing severe cuts in the state budget that 

may affect its supports for ending chronic street homelessness. Much of the funding for OMH's 

and CODAAP's supportive services, and even residential programs, comes from the state, where 

initial budget actions have made drastic cuts. 

Community Relations and Advocacy 

Having few resources available early on for either homeless individuals or individuals at-risk of 

becoming homeless, Philadelphia witnessed a drastic increase of chronic street homelessness. 

Initially, public attitudes were negative toward this popUlation and programs to meet their needs. 

In this section, we address how the city's advocates for programs to reduce chronic street 

homelessness assembled the necessary community support for their work. 

Initial Resistance 

At the same time that the city, nonprofit agencies, and advocates were moving to develop options 

to address homelessness in the early 1980s, many Philadelphia residents and elected officials 

opposed programs that assisted chronic street homeless individuals. In 1984 police arrested 

several service providers and advocates for giving food to homeless individuals in a Philadelphia 

train station. Also in that year, community residents sought to ban the opening of Women of 

Hope, one of the earliest programs to offer permanent supportive housing in the form of a "safe 

haven" for mentally ill women living on the streets. Opposition went so far as bomb threats to 

force relocation. Women began residing at the program as scheduled, and staff and residents 

worked hard to ease the fears of neighbors. 

The initial antipathy toward chronic street homeless persons and programs to meet their needs 

was a substantial challenge. Over time city officials, service providers, homeless advocates, and 

community and faith-based organizations came together to improve community relations for 

programs meeting the needs of homeless people. Their success was clear in the 1515 Fairmont 

dispute, when members of the public articulated their support for the building at the Mayor's 

public appearances, during radio call-in shows, and in many other ways. 

E.2S 
Appendix E: Philadelphia 

In 1997 following the closure of several community-based shelters, Project H.O.M.E. formed an 

ad hoc group known as-the "Open Door Coalition" to develop viable plans for permanent longterm supportive housing for homeless individuals. The Open Door Coalition was also 

responsible for soliciting support from the media and community residents to the Sidewalk 

Behavior Ordinance when it was fust proposed. Citizens representing many interests have 

participated in activities focused on planning and implementing approaches for ending 

homelessness, including the Blueprint (starting in 1996), and the current Mayor's Task Force on 

Homelessness. Business, in the form of the Center City District, has been active since at least 

1991 in addressing street homelessness, including providing jobs for homeless and formerly 

homeless people and funding street outreach. 

Set-aside funding in response to the Sidewalk Behavior Ordinance to expand street outreach was 

an additional approach the city used to improve relations between the business community and 

service providers. Street outreach has been crucial in helping homeless individuals move off the 

street; which was an objective of the business community to improve downtown visiting 

attractions. 

Another more forceful approach to overcoming public resistance was the Mayor's 2001 NTI to 

revitalize the neighborhoods of Philadelphia. One NTI objective is to foster the development of 

mixed-income housing units community-wide. NTI will preserve several neighborhoods by 

stabilizing, acquiring, and refurbishing certain vacant buildings. The NTI strategy is to help 

neighborhoods thrive by developing clean and safe places for residents to live and work. 

Although many advocates expressed concerns during the site visit that NTI will not do much to 

improve the housing needs of homeless people, the city's efforts have lessened the conservative 

fear that providing low-income housing will cause a decline in property values. In fact, Project 

H.O.M.E. is developing 144 units of affordable housing in one of the most upscale Center City 

neighborhoods, Rittenhouse Square, with substantial, active community support and no 

opposition. 

Several efforts have focused on giving citizens an avenue for expressing concerns about 

particular programs and services in their neighborhoods. The Department of Public Health, the 

Department of Human Services, and the University City Community Council formed a pilot 

project called the Good Neighbor Policy in 1998 to respond to neighborhood concerns or 

complaints regarding residential group homes within their communities. The Good Neighbor 

Policy has a help line for neighbors to call when they have an issue about a certain group home 

in their neighborhood. All complaints are handled by an appointed community point person who 

documents the complaint as well as the method used to resolve the issue. In addition to 

community complaints, the Good Neighbor Policy also handles issues related to safety, public 

transportation, and zoning requirements for residential group homes, which may include 

residences for formerly homeless people. 

Philadelphia also has a call-in line for issues relating to tenants with Section 8 housing subsidies. 

Section 8, one of the major sources for housing subsidies that help pay the rents of people 

residing in PSH, evidently has a very bad reputation in Philadelphia. Citizens appear to expect 

the worst behavior from households with Section 8 vouchers, which may be a general backlash 

against "welfare" or, as some suggested on our visit, may have racial overtones and reflect fears 

of neighborhood transition. To respond, the Philadelphia Housing Authority has a hotline that 

E.26 
Appendix E: Philadelphia 

citizens can call to report disruptive activities in particular housing units. Someone follows up on 

these calls and takes whatever steps are necessary to resolve the issues if they involve Section 8 

voucher holders. As often as not the calls turn out to be about people who do -not have a Section 

8 voucher, but the level of antipathy to Section 8 is reflected in the tendency of citizens to 

attribute anything bad that happens on their block to a Section 8 voucher holder. These attitudes 

make it hard to site new PSH programs, since their residents often rely on Section 8 to cover the 

cost of their housing. 

Good Neighbors Make Good Neighborhoods is a unique collaboration between Adult Services 

and the PHA. More than 400 families in the last 18 months have received Housing Choice 

(section 8) vouchers from PHA; with Adult Services providing intensive case management 

services for up to a year to stabilize these formerly homeless families in permanent housing. The 

case management role, in addition to helping the families directly, smoothes the relationships 

between families and landlords and possibly also between families and neighbors, contributing to 

both residential stability for the families and good interactions with neighbors. Through a grant 

from DHS, these families can receive up to $1,300 worth of furniture and household items for 

their new homes. In 2002, PHA committed an additional 300 vouchers to continue the program. 

To date, no families have been evicted from units in the program. 

Continuing NIMBY Issues 

As supportive as the general public's attitudes are toward assisting homeless people, in the 

abstract and in terms of supporting the city's continuing frnancial investment in programming, 

resistance still arises to specific programs that are proposed for specific blocks. The outcome of 

the 1515 Fairmount court case dampened enthusiasm for attempts to block development outright, 

but prospective neighbors still need to be approached with openness and delicacy. When Women 

of Change was proposed for the Logan Square neighborhood and neighbors voiced anxiety, 

program sponsors and city officials met with the neighbors to address their concerns and frnd 

ways to demonstrate that the program would fit smoothly into the neighborhood. They jointly 

formed an advisory board, which included city officials, neighbors, and the program sponsor, 

developed a legally binding grievance procedure. Happily, the grievance procedure has never 

been used since Women of Change (WOC) opened. 

Role ofConsumers in Advocacy and Shaping Policy 

Homeless people themselves have been involved from the beginning with Philadelphia in 

advocacy and actions to bring attention to the needs of people without shelter for the night. In the 

early 1980s, homeless people under the leadership of Chris Sprowl, Leona Smith, and Alicia 

Christian formed two organizations called Dignity and Fairness for the Homeless and the Union 

of the Homeless. They were very successful at organizing direct actions such as picketing 

shelters for inhumane treatment of people who were homeless, the lack of shelter, and the need 

for housing and jobs. Their efforts resulted in a "Right to Shelter" ordinance, the right of 

homeless people to vote, and Dignity Housing, a program to provide transitional and permanent 

housing run by those who have experienced homelessness. 

E.27 
Appendix E: Philadelphia 

Throughout the 1980s several public actions brought the plight of homeless ness to the public's 

attention. In the fall of 1987, Joe Rogers, a mental health consumer and a formerly homeless 

person who is a long-time leader in the mental health consumers movement, and Sister Mary 

Scullion, an advocate, invited people who were living on the street to join them in a vigil outside 

the State Office Building to testify to the need for more supported housing for those who were 

mentally ill and living on the street. Governor Casey sent the state's Secretary of Public Welfare 

to meet with those encamped outside and agreed to develop and provide operating support for 

150 units of housing that winter. In the following winter of 1988, homeless people and their 

supporters took over the basement of the Philadelphia Municipal Services Building to provide 

shelter for those who had none that winter, and refused to leave until the city made provisions for 

those still living outside. This move by homeless advocates brought attention to the issues of 

homelessness and the need for public support to assist in fmding solutions to end homelessness. 

In the 1990s, the focus was on addressing the critical need for affordable housing for single 

people and families as well as the need for jobs that paid living wages. Much of the activism 

arose from discrimination that faced those without a home, and used slogans such as "It is not a 

crime to be homeless," "People are more important than sidewalks," and "Homelessness is the 

crime not homeless people" to catch public attention and support. When Philadelphia's new 

Convention Center was set to open in the mid-1990s, anxiety focused on whether conventioneers 

would be reluctant to come because of people sleeping on the streets. Fortunately, the first 

convention was the National Conference of Mennonites. Local advocates met with some of the 

Mennonite leadership and they agreed to march with homeless people from the Convention 

Center to 1515 Fairmount to City Hall in solidarity with the plight of those who are low-income 

and without a home. This drew great press because it was the antithesis of what the city expected 

from conventioneers-a march on behalf of those who were sleeping outside. 

The role of the homeless advocates has also been very successful in rallying community support 

on the issues of homelessness in the political arena. For example, during the 1999 election of 

Philadelphia's mayor, homeless advocates formed a nonpartisan coalition called "Election '99: 

Leadership to End Homelessness," to educate the community through fonuns and workshops on 

the issues of homelessness, in addition to registering to vote over 2,000 homeless and lowincome individuals. Members of the coalition also organized a fonun with the mayoral 

candidates on homelessness and housing to examine the candidates' strategies for creating 

additional affordable housing units as well as obtaining their commitment to fmd solutions to end 

homelessness. The Candidates' Forum on Homelessness and Housing was attended by more than 

800 people; in addition, members of the coalition published and distributed throughout the 

community more than 10,000 copies of the Voters Guide on Homelessness and Housing. 

The efforts of the coalition continued during subsequent elections, in which members of the 

coalition lobbied to place homeless issues on the agenda of candidates seeking election in the 

2000 election of Philadelphia's State Senators and the 2002 election of the Pennsylvania 

Governor. Through websites, newsletters and pamphlets, members of the coalition have been 

able to educate voters on the election process and the candidate's political stances concerning the 

issues of homelessness and affordable housing. 

E.28 
Appendix E: Philadelphia 

Continued Vigilance 

The give and take of working together but stillioohng out for individual interests continues in 

Philadelphia. In 1999 an ad hoc group called the "Sidewalk Ordinance Task Force" began 

monitoring how police enforced the Sidewalk Behavior Ordinance and the commitment of the 

city to providing additional services that assisted homeless individuals. Through this task force, 

members of the community formed "Street-Watch," a collaborative of members from various 

organizations, to monitor the streets and ensure that homeless individuals were being treated with 

dignity and respect. Through evidence gathered during this monitoring, advocates were able to 

document less than complete adherence of police to the spirit of the Ordinance, and apply 

pressure to get the police to comply. Thereafter the p01ice department began working with 

community outreach teams to assist homeless individuals obtain shelter and services. 

E.29 
Appendix E: Philadelphia 

Philadelphia Site Visit Participants 

L-: 1_·­ I'~ 

-

Jenlene Arringon 

Stephanie Baralecki 

Lou Barnett 

Matthew Berg 

Carl Browne 

Jenny Burns 

Emily Camp~Landis 

Marsha Cohen 

Beverly Coleman 

Brenda Cooper 

Kathleen Coughey 

Mike Covone 

Gerard Devine 

Susan Dichter 

John Domzalski 

David Dunbeck 

Leticia Egea-Hinton 

Jonathan Evans 

Kim Flaville 

Elaine Fox 

Gloria Guard 

Elaine Harmon 

Harriet Herman 

Liz Hersh 

:1-:'" r....-;·, ­ ~ 

Philadelphia Health Management Corporation 

Project H.O.ME 

SELF, Inc. 

OESS 

SL John's Hospice 

Mary Howard Health Center/HCH/PHMC 

Office of Adult Services Managing Director's Office 

Homeless Advocacy Project 

Philadelphia l\Jeighborhood Development Corporation 

Horizon House 

Philadelphia Health Management Corporation 

BHS 

Office of Adult Services Philadelphia Housing Support Center 

Bethesda Project 

Department of Public Health 

Horizon House 

Office of Adult Services 

MHAIAccess, West Philadelphia 

Connelly Foundation 

Philadelphia Health Management Corporation 

People's Emergency Center 

OESS Intake for Single Men 

1260 Housing Development Corporation 

Pennsylvania Low Income Housing Coalition 

E.30 
Rob Hess 

Linda Hicks 

Keith Johnson 

Frank Jost 

William Kaiser 

Dee Kaplan 

Gerald Kaufman 

David Koppisch 

John Kromer 

Walt Kubiak 

Lynn Lampman 

Winnie Lau 

Marvin Levine 

Paul Levy 

Wes Lilly 

Jeannine Lopez 

William Maroon 

Sharmain Matlock-Turner 

Alba Martinez 

Joan McConnon 

Mary Melaragni 

Jennine Miller 

Dainette Mintz 

Jennifer Mitchell 

Genny O'Donnell 

Tom O'Hara 

Appendix E: Philadelphia 

Office of Adult Services Managing Director's Office 

. One Day_at a Time 

SELF, Inc. 

BHS/AAS 

Project H.O.M.E. 

Philadelphia Workforce Development Corporation 

Awbury Arboretum Association 

Women's Community Revitalization Project 

Fels Institute of Government, University of Pennsylvania 

1260 Housing Development Corporation 

Episcopal Community Services 

United Way of SEPA 

BHS/CODAAP 

Center City Business District 

Horizon House/Kailo Haven 

Project H.O.M.E. 

RHD/Ridge Avenue Shelter 

Greater Philadelphia Urban Affairs Coalition 

Department of Human Services 

Project H.O.M.E. 

Office of Housing and Community Development Policy and Planning 

Project H.O.M.E. Eduction and Advocacy 

Office of Housing and Community Development 

Ready, Willing, and Able 

Project H.O.M.E. OCC 

OMH 

E.31 
Barnabas Okeke 

Sandy Orlin 

Jeff Petraco 

Jim Piasecki 

Susan Pingree 

Joe Pinhak 

Harvey Portner 

Joye Presson 

Emily Riley 

John Ross 

Gregory Russ 

Joyce Sacco 

Sam Santiago 

Will Sassaman 

Mark Schwartz 

Sr. Mary Scullion 

Angelo Sgro 

Roberta Sharpe 

Susan Sherman 

Linda Staley 

Carla Stanford 

Marilyn Stewart 

David Thomas 

Steve Thomas 

John Thompson 

Melody Tingle 

Appendix E: Philadelphia 

OMH/MR Research and Information Management 

Mary Howard Health Center/HCH/PHMC 

Office of Social Services 

RHD 

Office of Social Services 

St. John's Hospice 

Professional Healthcare Institute 

People's Emergency Center 

Connelly Foundation 

Philadelphia Police Department 

Philadelphia Housing Authority 

RHD/Ridge Avenue Shelter 

Project H.O.M.E. OCC 

Hall-Mercer CMHfMRC of Pa. Hospital/UPHS 

Regional Housing Legal Services 

Project H.O.M.E. 

Bethesda Project 

Office of Adult Services Managing Director's Office 

Independence Foundation 

Philadelphia Housing Authority 

Horizon House Homeless Services 

Defender Association of Philadelphia 

Redevelopment Authority 

Corporation for Supportive Housing 

HUD 

Horizon House, Homeless Services 

E.32 
Appendix E: Philadelphia 

Bridgette Tobler OMH/Access to Alternative Services 

Deborah Wagner Catholic Social Services Holy Family Center 

John Wagner Catholic Human Services Archdiocese of Philadelphia 

Laura Weinbaum Project H.O.M.E. 

Sharon Welsh OMH/Access to Alternative ServiGes 

Mark Whiteman RHD/Kailo Haven/RHO Homeless Coalition 

JeffWilush Horizon House 

E.33 
Appendix E: Philadelphia 

Philadelphia Acronyms 

AS 

BHS 

CBH 

CDC 

CODAAP 

DCED 

DHS 

DHSS 

DPH 

HFF 

H.O.M.E. 

HSC 

HSDF 

IDIS 

MOU 

NTI 

OCC 

OESS 

OHCD 

OMH 

OSHA 

PHA 

PHMC 

PWDC 

RHD 

RWJ 

Adult Services 

Behavioral Health System 

Community Behavioral Health 

Community Development Corporations 

Coordinating Office of Drug and Alcohol Abuse Programs 

Department of Community and Economic Development 

Department of Hwnan Services 

Center for Mental Health Services 

Department of Public Health 

Housing For Families 

Housing, Opportunity, Medical Care and Education (Project H.O.M.E.) 

Housing Support Center 

Hwnan Service Development Funds 

Integrated Data Information System 

Memoranda of Understanding 

Neighborhood Transformation Initiative 

Outreach Coordinating Center 

Office of Emergency Shelter and Services 

Office of Housing and Community Development 

Office of Mental Health 

Office of Service to the Homeless and Adults 

Philadelphia Housing Authority 

Philadelphia Health Management Corporation 

Philadelphia Workforce Development Corporation 

Resources for Hwnan Development 

Robert Wood Johnson Foundation 

E.34 
APPENDIX F: SAN DIEGO 


San Diego-Brief Description 

San Diego is the nation's i h largest city, with a 2000 population of 1.2 million in a county of 2.8 

million. The-city has been gaining population steadily for several decades, 33 and passed the 1 

million mark with the 1990 census. The 2000 poverty rate for the city of San Diego was 14.6 

percent, higher than the nation's and San Diego County's, which were both 11.3 percent. The 

average 2002 unemployment rate for the San Diego MSA was lower than the nation's (4.1 versus 

5.8 percent).34 The military comprises an important part of San Diego's employment, even after 

base closings, and the city remains the main Navy port on the West Coast. Many military 

personnel and ex-military people live in San Diego, a fact echoed in its homeless population. 

About 40 percent of San Diego's single homeless people are veterans, compared to 26 percent 

for single homeless people in the whole country. 

San Diego's downtown area has undergone considerable redevelopment in recent years, adding a 

convention center, considerable waterfront development, office buildings, and both market rate 

and affordable housing. With development of each major downtown section, the homeless street 

people who frequented the area found themselves displaced. As downtown became revitalized, 

the issue of street homelessness and what to do about it became a focus of discussion. Some 

activities to address street homelessness were already under way when the decision was taken to 

build a new major league ballpark downtown, in an area that had become the most recent center 

of street homelessness. The impending ballpark development galvanized San Diego businesses 

and government agencies to get serious about reducing street homelessness in a responsible way. 

On our visit to San Diego on April 22-24, 2003, we interviewed 55 people. They represented city 

and county agencies; nonprofit outreach, drop-in, shelter, and housing providers; agencies 

serving homeless people through casework, mental health and substance abuse treatment, health 

care, and employment services; community development/neighborhood revitalization 

organizations; and law enforcement. People who had experienced chronic street homelessness 

were included in a separate focus group and as representatives of organizations for which they 

now work. A full listing of persons interviewed, other than focus group participants, may be 

found at the end of this appendix. 

Practices of Potential Interest to Other Jurisdictions 

San Diego's Special Needs Homeless Initiative has several practices that may be of interest to 

other communities; some it started and others were ongoing programs that the Initiative tapped. 

33 http://www.census.gov/prod/2002pubsiOOccdb/ccOO_tabCl.pdf. 

34 2000 poverty statistics for San Diego City, http://censtats.census.gov/cgi-binJpct/pctProfile.pl; poverty statistics 

for San Diego County, http://factfmder.census.gov/servletIBasicFacts; for United States, 

quickfacts.census.gov/stateslOOOOO.html; February 2003 unemployment statistics for San Diego County, 

http://data.bls.gov/cgi-binJsurveymost; for United States, www.bls.gov/cps/bome.htm#overview. 

F.l 
Appendix F: San Diego 

• 	 Police approaches-HOT, SIP. The San Diego Police Department has long been known 

as an innovator in developing approaches to resolve community issues. With respect to 

the chronic street homeless population, it participates with other agencies in two outreach 

teams that cover the major disabilities of mental illness and substance abuse. Homeless 

Outreach Team (HOT) combines uniformed officers, a mental health worker, and a 

benefits eligibility worker, who connect with the hardest-to-serve street homeless with 

mental illness, assess their needs, qualify them for services, and help place them in 

suitable programs. The Serial Inebriates Program (SIP) teams follow a Drug Court model, 

with officers who work as "probation officers" in enforcing court mandates, the San 

Diego Superior Court, the City Attorney's Office and the Public Defender to give chronic 

public inebriates living on the streets a choice between up to 180 days in custody or an 

alcohol treatment program, and caseworkers who follow people once they are in 

treatment. These programs have a high success rate and recover their costs by reducing 

expenditures on arrests, transportation, bookings, detox and emergency services. (Contact 

person: for HOT-Scott Bender, Sergeant, San Diego Police Department, 

sebender@pd.sandiego.gov; for SIP-Rich Schnell, Sergeant of Western Division and 

Police, San Diego Police Department, rschnell@pd.sandiego.gov; same phone number 

for both--6l9.692.4800.) 

• 	 Integrated Services for Mentally TIl Homeless People-REACH This county and city 

collaborative has placed over 250 mentally ill and dually diagnosed homeless persons 

into downtown housing and intensive case-managed treatment. San Diego Housing 

Commission (SDHC) helps fund the housing portion of the program while the statefunded AB 2034 program operating through the county Mental Health Services (CMH) 

funds mental health and other services through a flexible funding pool that will cover 

"whatever it takes." The county and city contract with non-governmental agencies to 

provide case management and supportive services. Nonprofits are assisting in the 

development of housing. (Contact person: Piedad Garcia, Project Manager, REACH, 

County of San Diego, piedad.garcia@sdcounty.ca.gov, 619.563.2763.) 

• 	 Ad Hoc Committee on Downtown Homelessness. An Ad Hoc Committee emerged 

when the downtown business association, city staff, county staff and developers needed 

to address the displacement of homeless persons anticipated from building a new 

downtown baseball park. The committee has no formal existence, and provides an open 

forum in which to establish goals, discuss issues and work out collaborative solutions. 

The participants are high-ranking individuals within their own agencies, with the power 

to make decisions and commit resources. The informal work of the Ad Hoc Committee 

has been the foundation for formal agreements and collaborative proposals to funding 

sources. (Contact person: Sharon Johnson, Homeless Services Administrator, City of San 

Diego, sIjohnson@sandiego.gov.) 

• 	 Joint RFP for Transitional Housing and Permanent Supportive Housing. The Centre 

City Development Corporation (CCDC), the City of San Diego, the County of San Diego, 

the San Diego Housing Commission, and the Corporation for Supportive Housing issued 

a joint request for proposals to develop and operate transitional and permanent supportive 

housing for special needs homeless persons. By coordinating the funding and proposal 

process, the Ad Hoc Committee facilitates the work of potential respondents and leads 

F.2 
Appendix F: San Diego 

them toward integrated services. (Contact person: Dale Royal, Senior Project Manager, 

Centre City Development Corporation, royal@ccdc.com, 619.533.7108.) 

• 	 Redevelopment Agency Incremental Tax Revenue Funds-CCDe. A redevelopment 

agency helps to create new developments and economic activity, generating new tax 

revenues for the jurisdiction. California law stipulates that the redevelopment authority 

receive back a share of these additional taxes (called tax increments), and says that the 

authorities must invest at least 20 percent of the money they get back to increase 

affordable housing (tax increment fmancing (TIF)). San Diego'-s Centre City 

Development Corporation invests these funds in affordable housing projects, some of 

which set aside about one-fourth of their units for the special needs homeless population. 

(Contact person: Donna L. AIm, Vice President, Marketing and Communication, Centre 

City Development Corporation, alm@ccdc.com, 619.533.7120.) 

• 	 Psychiatric-Family Practice Program Residents at Health Clinic for the HomelessSt. Vincent de Paul Village. The St. Vincent de Paul Health Clinic substantially 

strengthens its health services by partnering with the University of California San Diego 

Medical School to train interns with a dual residency in psychiatry and family practice. 

Frequently, the interns identify mental health issues when patients arrive with a medical 

problem. Treatment can normally begin immediately without referrals to other agencies. 

(Contact person: Margaret McCahill, Director, Clinical Services, St. Vincent De Paul 

Village, mmccarull@ucsd.edu, 619.233.8500 ext.l526.) 

Primary Contact Person 

Matthew Doherty, Program OffIcer 

Corporation for Supportive Housing 

1901 First Avenue, 2nd Floor 

San Diego, CA 92101 

Telephone: 619.232.3194 

Fax: 619.232.3125 

E-mail: matthew.doherty.csh.org 

History and Context-How the Current System Evolved 

Some significant activities to address chronic street homelessness were already under way in San 

Diego before the ballpark issue led to a coordinated community-wide response: 

• 	 A collaborative called Solutions, led by St. Vincent de Paul, formed in 1994 to provide 

coordinated services to the city's homeless population. Solutions brought together the 

primary nonprofit providers as well as a few small public agencies. 

• 	 In 1998, homeless advocates felt that the city was not doing enough for homeless people. 

They staged a camp-out in front of the municipal building, which grew over the course of 

a few months from a few people to more than 300. When the camp-out grew so large, the 

F.3 
Appendix F: San Diego 

police received an order to remove the campers because they were illegally occupying 

city property. The police department resp.onded in a unique maImer, out of its problemsolving, community-oriented approach. It brought a group of officers to the site and 

interviewed everyone there, asking who they were and what they needed to get off the 

street. The officers quickly realized that the issues raised required responses beyond 

anything the police could muster. Needs included access to public benefits, mental health 

and other services. Hot was born out of this realization, and the first HOT team launched 

as a pilot project. 

• 	 HOT combines police officers, mental health/substance abuse workers, and cash 

assistance eligibility technicians in teams that seek out the hardest-to-reach homeless 

people. Because they combine police and mental health expertise and authority, they are 

the only outreach teams on the streets that have the ability to remove people either 

voluntarily or involuntarily, in addition to building rapport and making referrals. By 

1999, HOT had just completed a successful pilot, documenting both that people could be 

helped and that it could save the city and county money being spent on crisis services and 

law enforcement. 

• 	 By 2000 the SIP was also being implemented. SIP is a "drug court" type collaboration of 

four city and five county agencies, including law enforcement, courts, health care, and 

homeless agencies. SIP forces chronic homeless inebriates to choose between extended 

time in jail or treatment and social services. 

As the potential displacement of homeless individuals by the planned stadium grew as an issue, 

Mike Madigan, a private developer who was in charge of the ballpark development, spearheaded 

a group that came to be known as the Ad Hoc Committee on Downtown Homelessness, made up 

of individuals from public agencies and the business community. The "think tank" players 

included Elizabeth Morris, CEO of the San Diego Housing Commission; Donna AIm, Vice 

President of Centre City Development Corporation (CCDC); Laurie Black, then president of the 

Downtown San Diego Partnership and an experienced advocate for homeless people with mental 

illness or co-occurring disorders; and Lynne Heidel, chair of the CCDC Board of Directors. 

People describe this group's approach as, "Our approach was to sit around the table and ask 

ourselves what should our approach be." Committee members think their success is due to the 

many conversations they had and their commitment to seeking information until they felt they 

knew what they wanted to do and something about how they could do it. 

Soon the San Diego City Manager provided resources in the form of Ann Hix, a planner from the 

City Manager's office. Ann, who estimates she spent half her time for a year on the effort, is 

described as "the glue that kept it all together." Madigan's and Hix's success in their roles as 

leaders of the effort is attributed to their neutrality. They started the process knowing nothing 

about homelessness or homeless programs but were willing to learn and had no preconceived 

ideas. They went everywhere, asked endless questions, brought fresh perspectives to existing 

programs, and thought about, "Why couldn't we do X?" rather than, "We've never done it that 

way." The combination of their politics also helped. One was a liberal public servant, the other a 

conservative businessman. When both of them agreed on a course of action, they tended to carry 

the day with audiences across the political spectrum. 

F.4 
Appendix F: San Diego 

Meanwhile, Heidel and Black kept the business community up to date with the Committee's 

thinking and garnered its support to move forward in a positive way to reduce street 

homelessness in the downtown area. 

By December 1999, the Committee's five-part Special Needs Homeless Initiative had been 

presented to and approved by the San Diego City Council. Its parts included: 

• 	 Creating a centralized intake and referral system and locating a facility; 

• 	 Building transitional housing beds for special needs homeless people; 

• 	 Building permanent supportive housing units for special needs homeless people; 

• 	 Expanding residential alcohol and drug treatment programs for substance dependent and 

dually diagnosed homeless people; and 

• 	 Evaluating and expanding the Police Department's Serial Inebriate Program. 

The Initiative's work has been facilitated by taking advantage of opportunities to draw on new 

resources: 

• 	 Under AB 2034, state funding for integrated services for severely mentally ill homeless 

people became available statewide (after a demonstration year in three counties under AB 

34) just as the Ad Hoc Committee was completing its formulation of the types of 

programs it wanted to develop for this population. San Diego County's Mental Health 

Services Division applied for a $10.3 million competitive grant, which was awarded in 

December 2000. 

• 	 The Corporation for Supportive Housing's initial efforts to open a San Diego office were 

then encouraged and supported by Hix and Madigan, so expertise in and resources for 

developing and operating permanent supportive housing became available. 

The committee met (and still meets) monthly. It drew in more and more agencies and resources 

as it identified needs and invited the participation of agencies that could help meet them. 

Meetings included self-education, inviting people to make presentations, and learning more 

about the issues and problems of San Diego's chronic street homeless popUlation, as well as 

identifying who could bring what resources to the table. In addition, Hix and Madigan spent 

hours visiting and interviewing providers about what they offered, speaking with homeless 

people, seeking information on potential models in use elsewhere and visiting some of them. 

Ultimately the approach selected was a comprehensive one, with plans to include everything 

from outreach through affordable housing. 

In winter 2002, CCDC, the City of San Diego, Corporation for Supportive Housing, County of 

San Diego, and the San Diego Housing Commission SDHC, the city's public housing authority 

developed a memorandum of understanding among themselves outlining resource and other 

commitments, and issued a first-ever joint request for proposals. This Request for Proposal 

(RFP) "To Develop and Operate Transitional and Permanent Supportive Housing Facilities in the 

F.5 
Appendix F: San Diego 

City of San Diego for Homeless Adults with Serious Mental Illness or Dual Diagnosis" invited 

qualified housing developers, nonprofit organizations, property owners, and development teams 

to submit proposals to begin to meet the second and third parts of the Committee's five-part plan. 

Responses to the RFP got the ball rolling on creating more supportive housing, representing a 

key strategic initiative for achieving the goals of creating 100 new transitional and 100 new 

permanent supportive housing units in the next several years. In addition, these agencies and 

others worked together to secure Assembly Bill (AB) 2034 funding for the Reaching out and 

Engaging to Achieve Consumer Health (REACH) program, which has gone a long way toward 

meeting the goal of central or coordinated intake for chronically homeless people with mental 

illness. 

Several circles of influence were essential in bringing the approach from plans to reality. These 

include: 

• 	 The Ad Hoc Committee. A small group of key decision makers from essential city and 

county departments plus the Downtown San Diego Partnership and the Corporation for 

Supportive Housing. 

• 	 Local elected officials. Part of the Ad Hoc Committee's success lies in drawing in 

players from both the city and county, in a spirit of cooperation that was unprecedented in 

San Diego up to that point. When the Committee was ready, it asked for, and got, an 

historic, first-time joint meeting of the City Council and County Board of Supervisors. 

These two bodies committed themselves to the plans offered by the Committee and to 

working together to make them happen. This public commitment was an important policy 

success. The City Council and Board of Supervisors created a Joint City-County 

Homeless Program Committee and appointed two members from each body to serve on 

it. These members in turn assigned staffers to work on the committee, which held regular 

meetings at which staff of city and county agencies reported progress toward various 

goals and discussed ways to reduce any barriers that arose. This Joint Committee became 

an important avenue through which city and county agencies could talk to each other and 

develop collaborative plans. 

• 	 The business community. CCDC works closely with the business community. The 

portfolio of one staffer, Donna Aim, includes responsibilities to "solve problems" in the 

downtown area, so homelessness fell into her bailiwick. In addition, the chair of the 

CCDC Board, Lynne Heidel, became very interested in the issue and provided essential 

leadership. Laurie Black at the Downtown San Diego Partnership also played a key role 

in educating the business community and bringing it to the table. Guest speakers educated 

both Partnership and Ad Hoc Committee members about homelessness, the relation of 

mental illness and co-occurring disorders to homelessness, and best practices elsewhere 

in the state and country to address the needs of chronically homeless people. 

The next section describes San Diego's approach to ending chronic street homelessness in its 

downtown area, including documentation of progress to date. Thereafter we give more detail on 

selected system components, examine funding mechanisms, describe how the current system 

evolved and where it is going, and describe issues that have arisen with respect to community 

relations. 

F.6 
Appendix F: San Diego 

Approach to Chronic Street Homelessness 

This section briefly describes the network of programs and services focused on reducing or 

ending chronic street homelessness among single adults. It also examines characteristics of 

people the system serves, how services are coordinated, and approaches or models in current and 

anticipated use. Continuum of care components addressing chronic street homeless ness are 

described in more detail in the section entitled "Selected System Components," along with 

activities and investments related to increasing the stock of affordable housing. 

San Diego's approach to ending street homelessness in its downtown area employs four 

strategies: (I) examining the problem systematically, asking what will resolve it, and inviting 

"whomever it takes" to help do the job; (2) outreach involving police coupled with appropriate 

casework and services; (3) using the power of the courts, in an adaptation of the Drug Court 

model, to address chronic street homelessness among people with addictions; and (4) developing 

safe havens and Permanent Supportive Housing (PSH) as part of a larger strategy to develop 

affordable housing. 

Program and Service Network 

San Diego's efforts to reduce and ultimately end chronic street homelessness crystallized when 

the Ad Hoc Committee on Downtown Homelessness formed and proceeded to develop the 

Special Needs Homeless Initiative. We have organized the overview table (Table F.l) showing 

San Diego's program and service network to highlight the public agencies and business 

association that are lead partners for the Initiative. The housing and supportive services providers 

who make up the downtown network follow in alphabetical order.35 Rows represent different 

providers; columns represent the types of programs and services offered. An "X" in a cell 

indicates that the provider offers that program or service. An "F" indicates that a public agency 

funds a program or service, and an "E" indicates that the provider offers expert advice, technical 

assistance, or training. 

Involvement ofMainstream Agencies 

As the rows of Table F.I for the lead partners in San Diego's Special Needs Homeless Initiative 

make clear, many public agencies have been actively involved as funders, service providers, and 

experts offering training and technical assistance. CCDC, the Division of Homeless Services of 

the Department of Community and Economic Development (DCED), and the San Diego 

Housing Commission are the chief funders among city agencies. Among them they support every 

component of the continuum of care, from outreach to affordable housing. CCDC may be of 

particular interest to other jurisdictions because it is a redevelopment agency. It funds homeless 

programs within the entire continuum of care using Tax Increment Financing as well as other 

resources, and also specializes in developing affordable housing in the downtown area with units 

35 Table F.! does not represent the entire network of homeless assistance programs and services in San Diego. These 

and other providers may also offer programs and services for single people with brief homeless experiences, as 

well as homeless families with children and homeless youth. 

F.7 
Appendix F: San Diego 

set aside for PSH. For a redevelopment authority, this is an unusual but exemplary level of 

involvement in providing solutions to chronic homelessness. 

Supportive services, both attached to housing and independent of it, are funded by DCED 

(employment) and the mental health and substance abuse services units of the county's Health 

and Human Services Agency. The county's mental health services unit also provides supportive 

services directly to homeless and formerly homeless people with the goal of helping them 

achieve stable housing. 

The San Diego Police Department is a key actor in the city's approach to ending street 

homelessness. The Deparquent's long-standing commitment to community-oriented policing, 

with its emphasis on solving problems rather than just arresting people, (Goldstein, 1990; Kessler 

and Wartell, 1996) contributes two highly effective programs. HOT-focusing on street people 

with severe mental illness-began as a pilot in 1998, followed in 2000 by SIP that focused on 

homeless alcoholics. Their success at helping people leave the streets gave them the evidence 

needed to expand beyond the pilot phase to their current countywide levels. 

Who Is Served? 

San Diego's efforts to end street homelessness in the downtown area focus on people with long 

histories of homeless ness plus one or more chronic health problems-primarily those with 

mental illness, substance abuse, or both. Development of safe havens has made it possible to 

accommodate people with major mental health problems but who may still be using drugs and/or 

alcohol. Chronic inebriates receive services through a variety of arrangements, including SIP's 

case management program. 

Coordination Mechanisms 

Planning and program development. The Ad Hoc Committee on Downtown Homelessness 

serves as the major coordination mechanism for planning, assembling resources, and developing 

programs related to ending street homelessness in downtown San Diego. The Committee meets 

monthly. It developed its comprehensive approach (from outreach to affordable housing), 

supported the design of the REACH Program/6 developed strategies for addressing the housing 

opportunities necessary so that all REACH program funds could be applied to supportive 

services, and supported coverage of other parts of the street homeless population through HOT 

and SIP. Now the Committee is turning its attention to next steps. 

36 Funded through a California state program that supports "Integrated Services for Mentally III Homeless People" 

and is known by its legislative bill number, AB 2034. 

F.8 
Appendix F: San Diego 

Table F.1: City of San Diego: Agencies Involved in Reducing/Ending Chronic Street Homelessness 

Homeless-Related Programs and Services 

·f 

! 

!!' 

0
 l ,p ff ff 

l'f (j , f () I ,:

-$? !!' I $ 4:, 

Q.!!' 03 o f ()<S Q..:;j 6 " c! 

I<i 

Nonprofit Programsl Servicesl Agencies Serving Currently or 

Fonnerly Chronic Street Homeless People (listed alphabetically) 

Special Needs Homele.s Initiative 

Lead Partners 

San Diego City Agencies 

Centre City Development Corporation (CCDC) F I F I F F x x x 

Police Department (PERT. HOT. SIP) x x x x x x Department of Community and Economic Development. F F F F F x x Division of Homeless Services 

Housing Corrvnission E.F IE.F I E.FI E.F I E.F x X.E 

Attorney's Office . Community Courts x x 

Downto"", San Diego Partnership (business association) X.F x x x 

San Diego County Agencies 

Mental Health Services X.F I X.F I FIX. F X. F X.F x x 

Alcohol and Drug Services F F F x 

Health and Human Services Agency x X.F F x x 

Public Defenders Office (re SIP) x x x 

Sheriff and Jail (re SIP) x x x x 

Support Services Partners 

Alpha Project (R) x X I I X X X X 

Catholic Charities (R) x x I I X X I X X x X X 

Comrnunity Research Foundation (R) X I X X X X X Corporation for Supportive Housing (R) E.F E x X E IX.E 

Episcopal Community Services (R) X Xix X X 

Family Health Centers of San Diego (R) x X X 

Mental Health Systems. Inc. (SIP . other case management) X x X X X 

San Diego Rescue Mission x I x I x X X 

Salvation Nmy X x I I X 

St. Vincent De Paul X XlxlXI X X X X X X X X X 

Senior Community Centers X XI X X X X 

T elecare lR) X X X X 

Vietnam Vets of San Diego x x X x x 

Volunteers of Nnerica X 

Local Elected and AppOinted Officials (Mayor. City Manager. City X X 

Council. County Board of Supervisors) 

X = Provider E = Expert T A Provider F = Funder R = Involved with REACH progr

F.9 
Appendix F: San Diego 

The Ad Hoc Committee includes all the major governmental and business entities involved in 

addressing street homelessness for downtown-San Diego. The committee has no formal 

existence, which members say is its strength. Its unbureaucratic and unofficial nature allows each 

participating agency and organization to be frank about its issues and tensions, as well as about 

its resources and abilities. Attendance by agency heads means that the power is present to make 

decisions, commit agency resources, and see that plans are carried to completion. Peer-to-peer 

accountability once commitments have been made keeps things moving forward, and peers can 

help troubleshoot bottlenecks and barriers ana offer their own resources to help regain 

momentum if things do not work as expected. 

Working with chronic street homeless people. Mental Health Services, Inc. (MRS) is the lead 

agency for the REACH Program, which coordinates services for mentally ill homeless 

individuals through many partners who together serve the complex needs of its target population. 

For the REACH Program, MRS contracts for outreach, case management, substance abuse, 

mental health, physical health, drop-in, and employment and training services. It also contracts 

for drop-in, safe haven, transitional, and permanent supportive housing, and with the San Diego 

courts to have a probation officer assigned directly to REACH to help clients with outstanding 

legal issues. 

Several outreach activities coordinate their efforts. HOT, covering the whole City of San Diego, 

is the first line of approach to disabled people living on the streets. Thanks to AB 2034 funding, 

HOT has 19 safe haven beds dedicated to people the team brings in, so HOT can get people into 

a bed as soon as someone says "yes." Teaming with an income maintenance eligibility worker 

adds another crucial element to the HOT teams' arsenal-the ability to connect street homeless 

people to public benefits that facilitate their getting off the street. 

HOT focuses on people who are more likely to have mental illness as a primary problem and are 

not likely to get arrested. HOT gets them into safe havens, board and care facilities, and skilled 

nursing facilities, depending on their level and type of need. When HOT encounters alcoholics it 

offers rehabilitation and help getting into appropriate care for those who are interested. 

SIP comes into play for chronic inebriates who do not seek treatment voluntarily. SIP is a 

collaboration of four city and five county agencies, including law enforcement, courts, health 

care, and homeless agencies. SIP works toward assisting chronic homeless inebriates to access 

treatment and social services. At this time (summer, 2003), an individual arrested by the San 

Diego Police Department for public intoxication will be taken to the Inebriate Reception Center 

for evaluation. As generally happens, this individual is identified by the Center as a chronic 

abuser of services or "Serial Inebriate" and refused admission. Police then take the individual to 

the county jail and place him into custody pending arraignment. At arraignment, the inebriate is 

sentenced to the maximum allowed by law (usually 179 days), and also informed that he may 

speak with a case manager, be assessed, and if approved for treatment, waive jail time to attend a 

treatment program. If the individual agrees, an assessment interview takes place and is used to 

determine whether the client is appropriate for treatment services (as a rule individuals with a 

history of violence, arson, or who are registered sex offenders are excluded). If the individual is 

considered appropriate for treatment, an order of release is drafted and the individual is released 

to the custody of the San Diego Police Department, which in tum transports him or her to the 

designated treatment center for intake. Reasons for denial mainly relate to the judgment that the 

F.lO 
Appendix F: San Diego 

person is not truly interested in treatment. As soon as a person is accepted into treatment and 

agrees to go, the caseworker will help resolve any issue or problem, including mental illness, 

dual-diagnosis, or corrections-related problems, through linkages within the casework 

organization attached to SIP. Failure to complete treatment results in issuance of a warrant and a 

return to custody. 

The San Diego City Attorney's office and the San Diego Superior Court work hand-in-hand with 

SIP. The City Attorney's office is organized by geographical area. It has a special unit of five 

attorneys plus a supervisor with responsibility for people in the downtown area who are longterm problems, and therefore also for legal problems related to homelessness. The unit gets all 

the SIP cases that come in for prosecution, which they handle vertically (the same attorney 

handles the case from beginning to end). Along with the Public Defender and the San Diego 

Superior Court, the unit has developed a sentencing structure ofjailor treatment modeled on 

drug court. This approach is "something different" for this population, for which the revolving 

door of arrest and detoxification was not working. The approach is also designed to reduce the 

impact of public drunkenness on the community. 

Pathways to Housing, Approaches and Models 

In addition to the traditional pathway of progressing through emergency and transitional housing 

to PSH, San Diego's street homeless population follow two routes that involve police outreach 

teams, and one that involves recruitment directly into housing. 

• 	 HOT to safe haven to housing. The HOT team brings chronically homeless people with 

a serious mental illness to one of the safe havens, where they can stay until they can be 

incorporated into REACH or other PSH arrangements. HOT can also put people directly 

into board and care or skilled nursing facilities, if their condition warrants such 

placement. 

• 	 SIP to court to substance abuse treatment to regular housing. Once a person arrested by 

SIP officers agrees to treatment, he or she usually moves to a transitional housing 

program and begins attending outpatient substance abuse treatment, or moves to a 

residential substance abuse treatment program. Twenty-two county-funded providers 

offer residential or outpatient treatment services and every client choosing to enter 

treatment has been housed during the treatment period. After completing outpatient 

treatment, the person may stay in transitional housing or, if employed, may move to his 

or her own residence. 

• 	 REACH Program (AB 2034) outreach to "housing " to PSH. REACH Program outreach 

workers or the HOT team makes initial contact. People who accept "housing" are 

usually moved to a shelter, hotel room, or safe haven until they can be placed in PSH. 

Selected System Components 

San Diego's Special Needs Homeless Initiative guides a system for reducing the downtown 

chronic street homeless population that includes most of the usual CoC components. As Table 

F.Il 
Appendix F: San Diego 

F.2 indicates, most of the agencies serving chronic street homeless people offer only a few 

aspects of a CoC rather than the whole spectrum. Only one, St. Vincent De Paul, comes close to 

being a mini-continuum within its own walls as it offers many interconnected CoC services. 

Several agencies within the system make outstanding contributions. The Police Department's 

role through HOT and SIP have already been noted. St. Vincent de Paul provides outreach/dropin, case management, all types of housing (emergency shelter, safe havens, transitional housing, 

permanent supportive housing and independent living) and support services related to substance 

abuse, mental health, and health problems. 

The Centre City Development Corporation, the downtown redevelopment agency, receives 

substantial funding from tax increment revenue derived from its redevelopment efforts and 

devotes a portion to developing housing for the downtown special needs homeless population. 

CCDC funds transitional and permanent supportive housing. It is also very active in creating 

affordable housing, which it extends to formerly homeless people by requiring some developers 

to set aside a significant proportion of units (sometimes as many as 25 percent) to be used as 

PSH for disabled formerly homeless people. CCDC also plays a strong role in advocacy, crossagency coordination, planning, and public relations. City and county agencies including SDHC, 

DCED, and CMH also play critical roles. 

Outreach and Drop-in 

San Diego's most innovative outreach programs are HOT and SIP, whose coordinative 

mechanisms have already been described. 

While the case management and treatment parts of SIP do not do outreach and receive referrals 

primarily through the court, the police team end of SIP is active on the streets. A significant 

proportion of HOT and REACH Program outreach is done through traditional methods of 

contacting individuals at emergency shelters, day centers, and food lines. When the REACH 

Program began, it did extensive outreach of this type to fill its treatment slots (250) within the 

short time allowed by the program. Once the REACH Program had its full contingent of clients, 

outreach dropped off considerably; many new clients come through HOT and the safe havens. 

But REACH Program staff still do some outreach through traditional channels, as do St. Vincent 

de Paul, San Diego Rescue Mission, Alpha Project, and Salvation Army. 

Emergency Shelters 

According to the Regional Task Force on the Homeless, in April 2002 the city had only 282 

emergency shelter beds for singles, but an estimated 4,450 unaccompanied homeless adults in 

the City of San Diego. San Diego's largest providers of emergency shelter emphasize linking 

their clients to case managers and transitional services, so turnover in the small number of beds 

is quite rapid 

One innovative emergency shelter service for women grew out of a day center operation. With 

REACH Program funding, Rachel's Women's Center extended its day services to provide an 

emergency nighttime drop-in center as well. In a large common area Rachel's accommodates up 

F.I2 
Appendix F: San Diego 

to 35 women during the night. It does not have beds or provide meals, but it does provide 

beverages andJarge comfortable chairs and sofas on which women can rest during nighttime 

hours. The room presents a non-threatening atmosphere with nice furnishings including tables, 

board games, televisions, and a video library. Open from 9:00 in the evening to 6:00 in the 

morning, Rachel's is known as a place where women can seek shelter at any time. 

During winter months, San Diego City funds the operation of a huge shelter tent for emergency 

shelter. Many street homeless people who avoid the regular emergency shelters do make use of 

the tent on the coldest nights, and thus become at least minimally known to the system. 

Low Demand Transitional Residences 

San Diego's Special Needs Homeless Initiative uses safe havens operated by Episcopal 

Community Services and low demand residences operated by the San Diego Rescue Mission and 

St. Vincent De Paul. CCDC helped fund the development of this housing, SDHC helps subsidize 

the housing and CMH helps fund substance abuse, mental health, and health services for the 

residents. 

Transitional Programs 

This is the largest category of residential assistance in San Diego's homeless assistance network, 

with 1,922 beds, although even here the city considers that it has a huge gap and could use two to 

three times as many transitional slots for singles. The largest providers of transitional housing for 

singles are St. Vincent de Paul, San Diego Rescue Mission, The Salvation Army, Vietnam Vets, 

the Alpha Project, Community Resources and Self Help, Inc., and the YWCA. Funding for 

supportive services in transitional housing programs comes from DCED and CMH, as well as 

directly from HUD. 

Transitional housing plays an important role in the REACH Program because there are not 

sufficient permanent supportive beds available and some participants need more intensive 

services that are available in existing permanent supportive housing programs. An increase in 

permanent supportive housing would reduce the wait for transitional housing by allowing more 

people to exit that stage. 

Permanent Supportive Housing 

As of April-2002, San Diego had only 382 permanent supportive housing beds for singles. 

Rough estimates of the number of chronic street homeless people in downtown San Diego range 

between 1,000 and 1,500, so even with the innovative programs already in existence or being 

developed, the city has some way to go to meet the need. 

St. Vincent de Paul, Episcopal Community Services, Alpha Project, The Association for 

Community Housing Solutions, and Pathfinders are the primary providers of permanent 

supportive housing for the Special Needs Homeless Initiative, although new providers will 

become involved as the units developed under the Initiative come on line. CCDC helps fund the 

F.l3 
Appendix F: San Diego 

development of many the housing units, with SDHC supplying Section 8 vouchers to pay the 

rents. San Diego County's Mental Health Services, Alcohol and Drug Services, and Health and 

Human Services Agency help fund the services, which are primarily provided through contracts 

with nonprofit agencies. Alpha Project also gets money ($1 million over three years) from 

California's Supportive Housing Initiative Act (SmA) for supportive services in the housing it 

operates. 

A crucial component in the Special Needs Homeless Initiative's support services is San Diego 

REACH, a program for mentally ill homeless individuals. MRS is the lead agency for REACH, 

San Diego's AB 2034 program to bring mentally ill street homeless persons into permanent 

supportive housing. SDHC, an equal partner in the program, supplies the housing subsidies 

(Section 8 vouchers). The participation of SDHC allows San Diego to use most of its AB 2034 

funding for supportive services and thus serve more people, instead of having to devote some of 

its state funding to housing as happens in some other California counties. 

AB 2034 expanded to new counties a pilot program to integrate services for homeless adults with 

serious mental illness. The Ad Hoc Committee seized this opportunity to put together and lobby 

for a joint proposal with city, county, business and nonprofit involvement. The committee sent to 

Sacramento a intergovernmental delegation of five that literally walked the corridors of 

California's capitol. The members impressed legislators with their degree of collaboration and 

fervor for the project, and the project was approved and implemented successfully. 

REACH met its enrollment goal of 250 formerly homeless, mentally ill and dually diagnosed 

individuals ahead of schedule. The REACH Program has many partners who together serve the 

complex needs of its target population. CMH, the REACH Program's parent agency, contracts 

with Telecare to perform outreach and provide case management services, and with Community 

Research Foundation to provide employment, rehabilitation, and recovery services, including 

substance abuse and mental health services to support REACH Program participants. Family 

Health Centers of San Diego addresses the physical health needs of REACH clients. Episcopal 

Community Services provides drop-in and employment services and safe haven housing 

opportunities. Catholic Charities' Rachel's Women's Center, including the nighttime drop-in 

center, is part of the REACH network. Alpha Project and TACHS operate housing units where 

REACH clients live, and TACHS also provides housing development and housing locating 

services. REACH also contracts with the San Diego County Probation Department to have a 

probation officer assigned to work directly with the REACH team. This officer is able to help 

many REACH clients clear up outstanding legal issues (for example, warrants, criminal 

background checks) in her role as liaison between clients and the courts. 

The success and popularity of REACH and 32 other AB 2034 programs funded throughout 

California is apparent from its continuing legislative support. Despite the state's fiscal crisis, the 

program continues to be part of the adopted 2003-2004 budget. 

To increase permanent supportive housing, the Corporation for Supportive Housing (CSH) 

facilitates proposals, trains agency staff, coordinates agency efforts, plans projects, advocates for 

projects and engages in general public relations and education. CSH had begun to implement 

planning initiatives in San Diego and was then actively encouraged in its efforts to open a San 

Diego office as a direct outgrowth of the Special Needs Homeless Initiative. Key Ad Hoc 

F.14 
Appendix F: San Diego 

Committee members learned ofCSH's purpose and activities and realized that it could offer a 

great deal of help in meeting the Initiative's goals. 

Supportive Services 

Two of San Diego's most important programs focused on chronic street homeless people use an 

interesting approach to delivering supportive services to keep people in housing-they contract 

with behavioral health companies, one for-profit and one nonprofit. REACH contracts with 

Telecare Corporation for mental health case management, while Mental Health Systems, Inc. 

provides assessment, case management, and substance abuse and mental health services for SIP 

participants. REACH Program participants may also access other providers for a variety of 

services. These companies are able to deliver appropriate care with workers who often are dualcertified for mental health and substance abuse treatment. They are also sophisticated enough to 

handle Medicaid (Medi-Cal in California) claims, and are able to fmance a significant portion of 

the services they provide through Medi-Cal billing (after getting clients onto Supplemental 

Security Income (SSI) and Medi-Cal). The more Medi-Cal pays for the services it will cover, the 

more program service dollars can be devoted to other service needs. 

Other agencies providing support services for people in permanent supportive housing through 

the Homeless Initiative are MHS (mental health), Catholic Charities (mental health), Family 

Health Centers of San Diego (health and mental health), Vietnam Vets (substance abuse), and 

Volunteers of America (substance abuse). 

St. Vincent de Paul Village (the Village) offers supportive services to people in its own housing 

programs and to the general population not living at the Village, whether or not they are or were 

chronically street homeless. It also offers a very important and otherwise unavailable service to 

chronic street homeless and other needy persons through its health clinic. Here, people who are 

not Medi-Cal beneficiaries can receive substance abuse, mental health, and health servicesincluding dentistry and eye care. The clinic is convenient to the residents of the Village's own 

housing programs; others must come to the Village site for care. The clinic is complete with 

examination rooms and diagnostic equipment. Patients can receive free dentures, which improve 

their appearance and self-image, and free glasses, which improve their vision and confidence. 

The Health Clinic strengthens its program by partnering with the University of California San 

Diego Medical School to train interns specializing in the treatment of mental illness and 

substance abuse. It offers the only program in the country where interns and residents can receive 

dual certification in psychiatric services and "homeless medicine." The Health Clinic also helps 

clients qualify for SSI, and thus Medi-Cal. Once on the Medi-Cal rolls, clients must transfer to a 

managed care organization for health care. Ironically, this may lead to a decline in the level of 

health care received, as St. Vincent's is certainly more attuned to the street homeless population 

than is the typical Medicaid managed care organization. Combining medical and social work 

expertise with over 15 years of experience, the Health Clinic has good first time success rates 

when it helps individuals fIle SSI eligibility applications. Most agencies in our study reported 

that SSI eligibility applications are usually bounced back at least once. 

F.1S 
Appendix F: San Diego 

Affordable Housing 

A lack of affordable housing affects chronic street homelessness just as it affects other 

homelessness, by creating pressures on households that are barely holding on to housing. SRO 

units and other inexpensive housing disappear, either through destruction or conversion to other 

uses, and people are displaced. For instance, at the same time the Ad Hoc Committee has been 

exerting effort to increase permanent supportive housing units, Federal courthouse expansion in 

downtown San Diego has "taken" the adjacent property-which was the San Diego Hotel, with 

400 Single Room Occupancy units occupied mostly by low-income elderly people. So after 

several years of effort, San Diego currently has fewer affordable efficiency units than it started 

with, even though it has new units to its credit. As in most communities, affordable housing is a 

major concern in San Diego. Due to pressures on housing prices, San Diego's homeless 

popUlation already includes a significant number of elderly people who are eligible to receive 

permanent supportive housing through the Senior Community Centers' development, which 

opened in August 2003. This senior housing complex may ease some of the pressure, but the loss 

of the San Diego Hotel threatens to at least double the current number of homeless seniors. Tens 

of thousands are assisted through housing programs, but hundreds of thousands are paying a 

painful proportion of their income for housing. The San Diego Housing Commission serves over 

29,000 households each year through rental assistance (Section 8), public housing, rental housing 

production, rehabilitation, homeownership, and resident services. 

SRO housing used to be the affordable housing of choice for single people with very low 

incomes. In San Diego as in most other cities around the country, SRO units were destroyed or 

converted to other uses throughout the 1970s and most of the 1980s. In the late 1980s and early 

1990s, San Diego experienced some restoration of SRO housing through innovative development 

and zoning practices, and used some of it to house homeless people. However, rents have been 

rising steadily, and are often now in the $600+ range for what is essentially less than an 

efficiency apartment--clearly beyond "affordability" for people living on SSI's $550+ or other 

public benefit programs or even Social Security. San Diego's stock of SRO units has also been 

reduced through destruction (loss of the San Diego Hotel to Federal courthouse expansion) or 

conversion (for example, of the Maryland Hotel to become a "boutique" hotel). SDHC has been 

working diligently to try to ensure enforcement of an SRO ordinance requiring replacement of 

any SRO units taken out of service, and also to get a stronger ordinance adopted by City Council, 

but has faced significant opposition to date. 

San Diego has some interesting fmancial tools for creating affordable housing. Although there is 

little hope that the growing need can be met in the foreseeable future, some of the housing is 

targeted for the special needs homeless population. CCDC is the redevelopment agency for 

downtown San Diego. California's Community Redevelopment Law requires that at least 20 

percent of all tax increments generated by a redevelopment project be used to increase affordable 

housing. Six percent of all new or rehabilitated housing in a redevelopment project area must be 

for very-l ow-income households (50 percent of area median income or below). CCDC 

contributes $6-7 million annually to a low and moderate housing set-aside fund that invests in 

projects providing affordable housing, including housing for special needs populations. The 

agency plans to use these funds to secure tax allocation bonds that could generate over $35 

million in secured debt financing. Countywide 10,136 units were created from 1992 to 2002, but 

F.l6 
Appendix D: Los Angeles 

probation, and the general intake process of the Cornerstone program. AB 2034 case managers 

go to the jail to conduct assessments when they receive referrals from the AB 2034 DMH 

Evaluator stationed at the jail. 

Emergency Shelters 

The AB 2034 program has eight designated beds (four for men and four for women) at the local 

Valley Shelter for clients who need immediate housing. The Valley Shelter is always open and 

provides three meals every day, so clients have no need to leave during the day except to attend 

mental health services at the AB 2034 program site. 

Transitional Program 

The San Fernando Valley CMHC AB program operates master-leased, scattered-site units, with 

lengths of stay ranging from short-term transitional (28 days) to more long-term options (three 

months to one year). The program requires clean and sober living for a minimum of three months 

before admission into housing and has a zero tolerance policy for substance use once in 

residence. Residents found to be using drugs or alcohol during random drug tests are asked to 

leave the residence for two weeks with a number of options that would allow the resident to 

come back into housing earlier if she or he complies with a harm reduction plan of action, which 

includes drug and alcohol treatment. Residents are also required to save money in preparation for 

their eventual transition into Section 8 housing. 

Program staff members will also place clients into other transitional housing programs if no 

openings are available in the Center's own housing continuum. For example, until they fmd a 

Section 8 living accommodation, some ciients are placed in sober living homes. 

Permanent Supportive Housing 

The AB 2034 program has access to permanent supportive housing units in a number of different 

low-income housing buildings in the area, supported by SRO Mod Rehab, city Section 8 

homeless vouchers and city and county Section 8 Shelter Plus Care vouchers. The Center 

program in partnership with A Community of Friends (a low-income, special needs housing 

developer) will place AB 2034 clients into a new permanent housing building scheduled for 

opening in January, 2004. Residents will be able to live independently but will be required to be 

involved in meaningful activities a minimum of 20 hours a week. 

Supportive Services 

AB 2034 services are available 24 hours a day, seven days a week and include medication 

support, substance abuse services, mental health counseling, housing location assistance 

(including temporary, transitional, and permanent housing both on and off the Cornerstone 

program site), vocational and employment services, benefits assistance, money management, 

showers and hygiene services, laundry facilities, meals, telephone and voice mail access, 

advocacy in the criminal justice system, advocacy in the mental health court, life skills training, 

D.27 
Appendix D: Los Angeles 

and crisis intervention (Hunter, et ai., n.d.). Staff members meet with their clients regularly, 

perhaps even daily, depending on the needs of the client. If program clients return to jail, case 

managers advocate for them during the court hearing to request a conditionaL release back to the 

program. Staff members carry caseloads of 16 clients, about 4 to 5 of whom live independently 

but still receive case management services. 

AB 2034-Community Relations and Advocacy 

The San Fernando Valley CMHC fmds that when it comes to neighbor relations, the key to 

successfully placing housing units in existing neighborhoods is having resident managers on site. 

Resident managers are able to monitor residents for program compliance and safety of the 

community. Another key component to reducing resistance to housing homeless individuals in 

neighborhoods is listening to the community concerns. After listening to the community's 

concerns and participating in a Resident Council Meeting about clients loitering on the streets in 

front of its housing unit, the program staff placed a gate between the residence and the 

Cornerstone property to reduce the visibility of its clients in the neighborhood. 

This is not to say that there have been no difficult experiences with neighbors. The San Fernando 

Valley CMHC met neighbor opposition when moving to its current location in 1997 and when 

developing a transitional housing program. In both cases, a local neighbor advocated against 

homeless programs and complained to the city council about the program location. As there were 

no complaints on record about the program residents in either situation, the city council did no~ 

act to change the locations. Since that time, the Neighborhood Council embraced the program 

and the Center's resident managers are a visible part of the Neighborhood Watch Group. 

Lamp Community 

Renowned as being an industrial hub for entertainment, technology, tourism, trade, 

manufacturing, fmance and communication, Los Angeles is also a city of extremes. Adjacent to 

its financial district sits Skid Row, a 40 square block area that holds a concentration of Los 

Angeles' poorest, most difficult to serve homeless people. A member of the focus group 

commented that when he first came to Skid Row someone said to him, "Welcome to the gates of 

Hell. If you can stay sober here, you can stay sober anywhere." Lamp Community serves this 

population using a model of care specifically designed to serve hard-core homeless individuals 

with serious mental illnesses and substance abuse problems. 

Lamp Community History 

Homelessness became a major issue in Los Angeles after the deinstitutionalization of people 

with mental illnesses followed by severe budget cuts to mental health programs. Many formerly 

institutionalized mentally ill men and women became homeless and were sent to the missions on 

Skid Row, but had no safe place to spend their time during the day. In response to this problem, 

Mollie Lowery partnered with Frank Rice, vice-president of Bullocks department store in 1985 

to found L.A. Men's Place as a drop-in center. Since then Lamp has evolved into its current 

D.28 
Appendix F: San Diego 

a gap of 6,627 units still remains in the very-low income category. The five-year goal is to add 

1,200 units to the very-low income inventory. 

Documenting Reductions in Chronic Street Homelessness 

Movement ofStreet Homeless into Housing 

• 	 REACH37-from inception through January 31,2003, San Diego's REACH program had 

enrolled 404 W1duplicated homeless individuals with severe-mental illness. Of these, 253 

are still enrolled and 154 had been disenrolled for various reasons (59 percent dropped 

out of the program and another 17 percent moved out of the REACH program area). 

• 	 REACH had the following impacts, annualized to represent the 12 months before 

compared to the 12 months after enrollment. The 253 clients currently enrolled have had: 

~ 73 percent fewer homeless days; 

~ 55 percent decrease in incarceration days, and 71 percent decrease in incarceration 

episodes; 

~ 35 percent decrease in hospital days, and 62 percent decrease in hospitalization 

episodes; 

~ 85 percent increase in people receiving cash and other public benefits (usually health 

insurance, food stamps, SSI, other cash assistance; does not include housing 

subsidies, which most REACH clients have); and 

~ 506 days of enrollment, on average, or about 1.4 years, in a program that in January 

2003 had only been at full enrollment for about two years; 55 percent had been 

enrolled at least one year. 

• 	 SIP presents a variety of impact data. 

~ HOT asked the UCSD Medical Center to track care received by 15 mentally ill 

chronically homeless individuals well known to the HOT workers. Care received was 

tracked at Scripps Mercy Hospital, UCSD Medical Center, and the San Diego 

emergency medical services system during an 18 month period from July 1, 1997 

through December 31, 1998. The I8-month cost just for these 15 individuals was just 

W1der $1 .5 million, which did not include physician fees or care that might have been 

incurred at other regional hospitals. UCSD physician charges totaled $87,017 for 

both in- and outpatient care for these same individuals during the study time period. 

At $69,820 a person a year, HOT did not have to say much more to argue for the cost37 	 Data supplied by Dave Pilon, director of the statewide outcomes collection and reporting system for AB 2034. 

Questions about REACH data should be referred directly to Mr. Pilon, at dpilon@mhala.org or (562) 285-1330 

Ext. 249. Outcomes are based on 253 current clients; reasons for leaving are based on the 154 clients who 

disenrolled from REACH as of January 31, 2003. Information about the period before enrollment comes from 

client self-reports; post-enrollment information comes from REACH case records. 

F.17 
Appendix F: San Diego 

effectiveness of its activities to get chronic street homeless people with multiple 

disabilities into stable housing situations. 

~ SIP did a cost analysis showing the very high levels of public resources being 

absorbed by serial inebriates, compared to the costs of treatment. They calculated a 

cost of $977 for maintaining one serial inebriate in housing plus outpatient substance 

abuse treatment for one month, compared to $1,470 for the cost of one police contact 

with an ambulance visit to the emergency room followed by a day in jail. 

~ In SIP's 2000 Pilot year, 144 people were arrested an average of 1.9 times. Of these, 

72 percent were assessed for treatment (1 04 people) and almost half (48) were 

accepted. Twenty-two people completed treatment (46 percent of those accepted, 21 

percent of those assessed, and 15 percent of those arrested). The 46 percent 

completion rate compares well with the of average completion rates for voluntary 

substance abuse treatment among homeless people of between 20 and 33 percent, 

with most falling at the lower end (Orwin, et aI., 1994). And the SIP participants were 

all people with very long histories of addiction and street homelessness, and all were 

treatment resisters. 

~ In addition, 58 percent of those arrested (72 people) did not have additional police 

contact or local emergency room use for over one year, whether or not they ever 

entered or completed treatment. They may have left town or been injail, or they may 

have been successful treatment completers. 

~ In Calendar year 2001 SIP expanded to include Central and Northern Divisions, 

There were 241 people arrested an average of 2.4 times. Of these, 65 percent were 

assessed for treatment (157 people) and almost half (71) were accepted. 39 people 

completed treatment (55 percent of those accepted, 25 percent of those assessed, and 

16 percent of those arrested). In Calendar year 2002 SIP expanded to cover the whole 

City of San Diego and some parts of the county. 249 people arrested an average of 

2.03 times (fewer repeat arrests than in 2001). Of these, 76 percent were assessed for 

treatment (190 people) and about one-third (68) were accepted. Twenty-nine people 

completed treatment (43 percent of those accepted, 15 percent of those assessed, and 

12 percent of those arrested). 

Public Funding 

The Special Needs Homeless Initiative agencies that fund housing and services draw on local, 

state and Federal mainstream sources (see Table F.2). In addition, the agencies within the 

Initiative providing services receive private funding from many individual, corporate, and 

nonprofit foundation sources. The Housing Commission is the biggest funder of housing, and its 

monies from Section 8, SHELTER PLUS CARE, and City Public Housing programs are 

especially important for helping the special needs homeless population get off the street. 

CCDC gives the greatest impetus for affordable housing in the downtown area. CCDC efforts are 

funded by incremental tax revenue raised from its development projects. CCDC targets a portion 

F.l8 
Appendix F: San Diego 

Centre City Development Corporation 

(CCDC): tax increment resources, other x 

local resources 

Department of Community and Economic 

Development (DC ED), Division of x x 

Homeless Services: CDBG; ESG, general 

revenue 

San Diego Housing Commission (SDHC): 

Section 8, HOME, Housing Trust, 

SHELTER PLUS CARE, public housing x 

x x x 

x x 

of these funds towards residential developments which have a share of their units set aside for 

the special needs population. 

DCED commits funds from CDBG and ESG monies to provide housing and services for the 

special needs homeless. DCEC's Division of Homeless Services conducts this work. 

The County's Mental Health Services and Alcohol and Drug Services also fund some beds for 

special needs homeless people. However, these agencies' primary role within the Initiative is to 

provide services. Mental Health Services administers AB 2034 funds for REACH. The outreach, 

case management and support services from this program are vital parts of the Initiative. 

The Initiative's success rests on a coordinated pooling of resources from city, county, and 

nonprofit agencies. REACH is a good example of this approach, as SDHC provides most of the 

housing subsidies and funding for all of the case management and support services comes 

through MRS. 

F.19 
Appendix F: San Diego 

Maintaining and Enhancing the System 

Huge gaps still exist in San Diego's arsenal of programs and services to end street homelessness. 

The Ad Hoc Committee continues to meet, and to pursue resources that will help it continue to 

meet its goals. For instance, Committee members helped foster and support San Diego's 

response to the recently issued Federal Chronic Homeless Initiative Notice of Funds Availability. 

Further, due to the REACH Program's success, MRS was invited to apply for funding to expand 

the program into northern San Diego County. Those expansion funds were awarded, but then 

almost immediately rescinded due to state budget issues. The Committee will be working to try 

to sustain the AB 2034 program statewide in the face of massive state budget cuts, especially 

since its approved North County application appears to have lost its funding to these cuts. It will 

be working to educate the newly elected members of the City Council about homeless issues and 

what remains to be done to address them. It anticipates working with the mayor and city manager 

to continue to set goals for producing more permanent supportive housing. The same openness, 

non-defensiveness, and problem-solving orientation that brought it success to date are evident in 

its approach to its recent applications, and are expected to extend to work in the future. 

Community Relations 

An important part of community relations for the Special Needs Homeless Initiative was to bring 

on board the business community and city and county government leaders. Quite deliberately the 

Ad Hoc Committee built a core of influential members from these sectors as its work progressed. 

Fortunately, for a number of reasons, the willingness to help homeless people cut across 

organizations and political ideologies. Downtown businesses facing a concentration of street 

homeless individuals had self-interest in supporting programs that reduce homelessness in the 

area. The police department was instituting proactive and resource effective programs, to help 

treat the special needs homeless population, rather than just recycle them from the streets to jail 

and back. Furthermore, many people in positions of power in the private and public sectors had 

been touched by substance abuse and mental illness problems through family members or 

friends. The key to successful community relations was to make a convincing case that a 

program could work with the special needs homeless popUlation. 

The Initiative houses many participants in large residential developments where they are not a 

conspicuous presence. This appeals to the participants and reduces neighbors' fears that there 

will be a negative impact on their area. In higher-income neighborhoods, the Initiative has 

constructed or rehabilitated multi-unit structures in a manner that meets the area's standards. 

These residential facilities are usually for 20 to 40 individuals and are often functioning 

unnoticed by most of the public. Some of the program's residential units are in low-income, 

mixed use, decaying neighborhoods scheduled for redevelopment. These are not the best settings 

for the participants, but there are fewer NIMBY issues when the program facilities are improving 

the neighborhood. 

F.20 
San Diego Site Visit Participants 

Donna Aim 

Scott Bender 

Adrienne Berlin 

Burns 

Mary Case 

Hannah Cohen 

Doherty 

Glenn Duke 

Loren England 

Debra Fischle-Faulk 

Piedad Garcia 

Larry Graff 

Karen Gurn 

Lauri Hess 

Anne Hix 

Kathleen Houck 

Gary Hubbard 

Jonathan Hunter 

Sharon Johnson 

Kevin Kmiec 

Betsy Knight 

Karna Lau 

Deborah Lester 

John Liening 

Marry Manaster 

Appendix F: San Diego 

Centre City Development Corporation 

San Diego City, Police Department. Homeless Outreach Team 

San Diego County, HSSA, Adult Mental Health Services 

Diego Reach I T elecare Corporation 

Supportive Housing 

P.E.R.T INC. 

Salvation Army 

City of San Diego, Community and Economic Development 

San Diego County, HSSA, Adult Mental Health Services 

Alpha Project 

National Alliance for the Mentally III, San Diego 

Community Research Foundation 

San Diego City, Park and Recreation 

ing Commission 

San Diego REACH I Telecare Corporation 

Corporation for Supportive Housing 

San Diego City, Community and Economic Development Dept. 

Episcopal Community Services, Friend to Friend Clubhouse 

Episcopal Community Services, Friend to Friend Clubhouse 

, Probation Department, 

San Diego Regional Task Force on the Homeless 

San Diego City, Police Department, Serial Inebriate Program 

San Diego Housing Commission 

F.2l 
Appendix F: San Diego 

Margaret McCahill St. Vincent De Paul Village 

Deni McLagan Mid-Coast Regional Recovery Center 

Elizabeth Morris San Diego Housing Commission 

Marcella Ordorica Office of City Attorney 

Jason Ortiz Telecare Corporation 

Mathew Packard St. Vincent De Paul Village 

Debbie Parum Telecare Corporation 

Tony Potter San Diego County, HSSA, Adult Mental Health Services 

Joy ptashhein Family Health Center of San Diego 

Karol Rhoades Mid-Coast Regional Recovery Center 

Dale Royal Centre City Development Corporation 

Richard Santoni Telecare Corporation 

Richard Schnell San Diego City, Police Department 

Theresa Simms St. Vincent De Paul Village 

Randy Solomon Alpha Project 

Solidad Urbina The Salvation Army Social Services, San Diego County 

Suzy Valenzuela Episcopal Community Services, City Works Plus 

David Vincent Family Health Centers of San Diego 

Gwen Vitkus Community Research Foundation 

Sherry Wilkins Community Research Foundation 

Roy Williams Mid-Coast Counseling & Recovery Center 

Anne Wilson Community Housing Works 

Alex Zazueta San Diego County, HSSA, Family Resource Bureau 

Jeff Zinner Centre City Development Corporation 

F.22 
Appendix F: San Diego 

San Diego Acronyms 

AB 

CCDC 

CDBG 

CMR 

CRASH 

CSH 

DCED 

EHAP 

LTHTC 

HOT 

Medi-Cal 

MHP 

MRS 

NlAAA 

NO FA 

PHA 

REACH 

RFP 

SDHC 

SDPD 

SHIA 

SIP 

SRO 

SSI 

TACHS 

TIF 

Assembly Bill 

Centre City Development Corporation 

Community Development Block Grant 

San Diego County Mental Health Division 

Community Resources And Self Help 

Corporation for Supportive Housing 

Department of Community and Economic Development 

Emergency Housing Assistance Program 

Low-Income Housing Tax Credits 

Homeless Outreach Team 

California's Medicaid Program 

Multifamily Housing Program 

Mental Health Services, Inc. 

National Institute on Alcohol Abuse and Alcohol 

Notice of Funds A vailabili ty 

Public Housing Authority 

Reaching out and Engaging to Achieve Consumer Health 

Request for Proposal 

San Diego Housing Commission 

San Diego Police Department 

Supportive Housing Investment Act 

Serial Inebriates Program 

Single Room Occupancy 

Social Security Income 

The Association for Community Housing Solutions 

Tax Increment Financing 

F.23 
Appendix F: San Diego 

F.24 
APPENDIX G: SEATTLE 


Seattle--Brief Description 

Seattle, a city with a population of 600,000 in a county of 1.4 million has some economic 

advantages over the nation on average. Seattle's 2000 median household income was slightly 

higher than that of the nation ($45,736 and $41,994, respectively) and the poverty rate was 

slightly lower (6.9 percent for families and 11.8 percent for individuals versus ·9.2 for families 

and 12.4 for individuals).38Its 2002 unemployment levels were above the national rate, however, 

(6.8 percent for Seattle and 5.8 percent nationally). 39 

Like many cities, Seattle faces a housing affordability crisis. Because of the economic boom 

Seattle experienced during the 1980s and 1990s, the cost of housing has increased substantially. 

Housing prices have increased 67 percent since 1995 and rental prices have increased 37 percent 

in the past seven years. A one-bedroom apartment in Seattle costs about $786 per month, or 

approximately 66 percent of a full-time minimum wage worker's salary.4o During this same time 

frame, Section 8 project-based contracts expired and the local government spent millions 

purchasing the buildings to maintain the Section 8 housing, leaving little money to create new 

spaces. Also during this time providers developed many supportive housing programs. These 

supportive housing units were not meant simply to replace affordable housing or project-based 

Section 8 housing, but that has been the effect in the increasingly out-of-reach rental market. As 

a result, despite the fact that the number of people homeless at a point in time in Seattle 

decreased during the 1980s, it began to increase again in the 1990s and the street popUlation 

continues to experience sharp increases. 

Practices of Potential Interest to Other Jurisdictions 

Seattle and King County have several practices of potential interest to other jurisdictions: 

• 	 Providing Support Services Matters. Plymouth Housing Group (PHG) has documented 

the importance of providing support services to the residents in the population it serves. 

PHG started the Support Services Division of the agency in 1996. Before the agency 

provided support services to their residents the average length of stay in housing was 18 

months, and since it has provided support services to residents the average length of stay 

has increased to 36 to 38 months. (Contact person: Tara Connor, Director of Social 

Services, tconnor@plymouthhousing.org ) 

• 	 Housing Tax Levy. The City of Seattle has a housing tax levy that has been a catalyst for 

developing permanent supportive housing in Seattle. Four times since 1981, voters have 

approved legislation that taxes homeowners to raise capital to develop housing. The levy, 

averaging $49 per homeowner annually, provides initial capital funding for renovation or 

38 Infonnation from Quick Tables, US Census Bureau: http://factfmder.census.gov. 

39 lnfonnation for unemployment rates from bttp://www.bls.gov/cpslhome.htm#overview. 

40 lnfonnation from Seattle Office of Housing: http://www.cityofseattle.netlhousing 

G.! 
Appendix G: Seattle 

new structures and helps nonprofit agencies leverage other funding sources to develop 

housing. The levy also provides funding for operating costs for housing. (Contact person: 

Bill Rumpf, Deputy Director, Office of Housing, bill.rumpf@seattle.gov, 206.615.1577.) 

• 	 Special Outreach to Chronic StJ:eet Homeless MentaUy III Persons. Seattle has two 

specialized outreach programs that provide workers who interact one-on-one with 

homeless mentally ill persons until trust is established. These are the Mental Health 

Chaplaincy and the Downtown Emergency Services Center's, Homeless Outreach, 

Stabilization, and Transition (HOST) Project. Mental Health Chaplaincy workers walk 

regular routes through downtown Seattle and at the end of each day visit inpatient mental 

health units. HOST Project workers initiate engagement processes with mentally ill 

homeless persons on the street, in emergency shelters and in drop-in centers. (Contact 

person: Craig Rennebohm, Director, 206.622.2472. Bill Hobson, Executive Director, 

bhobson@desc.org, 206.464.1570, ext. 30 15.) 

• 	 Mental Health Information System. Seattle's providers of mental health services 

maintain a shared client database. This supports a process to alert mental health providers 

when their clients unexpectedly enter another component of the system. Once a person is 

logged into the Mental Health Information System, a countyvVide agreement assures that 

local jails and hospitals notify the mental health providers (including those that are 

homeless service providers) if their client is incarcerated or admitted for services. 

(Contact person: Diep Nguyen, Information System Coordinator, 206.296.5213.) 

• 	 Multi-agency Teaming for High Utilizers of Public Crisis Services. At biweekly 

meetings staff members from several agencies meet to discuss treatment strategies for 

known high service users of the Crisis Triage Unit and the Sobering Support Center. In 

some cases, clients and their families participate in the planning. (Contact person: 

Edward Dwyer-O'Connor, Crisis Triage Unit Program Manager, 

capeo@u.washington.edu, 206.731.5846.) 

• 	 Section 8 as part of the Continuum of Care. Seattle Housing Authority and King 

County Housing Authority have also set up a system whereby people in Shelter Plus Care 

pennanent supportive housing can stay on the waiting list for Section 8 vouchers and 

access this housing program when they no longer are in need of the level of services 

Shelter Plus Care requires. (Contact person: Sheila Fries, Shelter Plus Care Program 

Manager, Plymouth Housing Group, sfries@plymouthhousing.org, 206.267.4707.) 

Primary Contact Persons 

Bill Hobson, Executive Director 

Downtown Emergency Service Center 

507 Third Ave. 

Seattle, WA 98104-2304 

Telephone: 206.464.1570 

Fax: 206.624.4196 

E-mail: bhobson@desc.org 

G.2 
Appendix G: Seattle 

Alan Painter,nirector 

Community Services Division, Human Services Department 

City of Seattle 

618 Second Ave., 7th Floor 

Seattle, W A 98104-2232 

Telephone: 206.684.0263 

Fax: 206.684.0146 

TTYITDDL: 206.684.0274 

E-mail: alan.painter@ci.seattle.wa.us 

Patrick Vanzo, Administrator 

Cross Systems Integration Efforts 

King County Department of Community and Human Services 

821 Second Ave., Suite 600 

Seattle, W A 98104-1598 

Telephone: 206.296.0615 

Fax: 206.296.5260 

TTY ITDDL: 206.296.5242 

E-mail: patrick.vanzo@metrokc.gov 

Davi<l M. Wertheimer, Principal 

Kelly Point Partners 

600 First Avenue, Suite 305 

Seattle, W A 98104 

Telephone: 206.914.4475 

Fax: 206.903.9579 

E-mail: david@kellypointpartners.com 

History and Context-How the Current System Evolved 

In the late 1970s, the Downtown Human Service Council Group, a private nonprofit policy group 

that advocated to the Seattle and King County governments, noted increases in street homeless 

individuals and the increase in mentally ill people who were not getting the services they needed. 

As a result of these concerns, the mayor's office helped initiate the Downtown Emergency 

Services Center (DESC). DESC, a non-profit organization opened in 1979, boosted substantially 

Seattle's services for chronic street homeless individuals. Since its inception its "unofficial" 

mission has been to reach out to mentally ill and chemically dependent street homeless people 

using a service structure that would not create barriers to access. Although it was not named so at 

the time, they essentially called for a low demand approach. In 1980, the state certified DESC as 

a mental health treatment provider and King County government contracted with it to provide 

acute case management services. In 1985, Seattle received one of the fust Health Care for the 

Homeless (HCH) grants from the Robert Wood Johnson Foundation (RWJ), making it possible 

for DESC to have on-site nursing staff, mental health, and drug/alcohol services through 

Harborview Medical Center's Pioneer Square Clinic. From its beginning, DESC had strong ties 

G.3 
Appendix G: Seattle 

to the city and the county, which are among its funders; and Clark Kirner, Deputy Chief of the 

Seattle Police Department, chairs the DESC Beard of Directors. 

During the same time frame, Community-Psychiatric Clinic (CPC) began to develop housing for 

its patients. CPC was originally formed in 1953 to provide affordable traditional mental health 

services for those who could not access such services. Over the years, however, CPC staff 

realized that a large proportion of their clients were homeless, including a portion who were 

chronically homeless, and that they could not effectively serve clients who did not have stable 

housing. So, in 1983 CPC partnered with the Seattle Housing Authority to develop its ftrst 

housing program and residential treatment program. Over the years CPC has continued to 

develop housing units of residential treatment (including a save haven housing program and an 

emergency respite care program), supported living, and independent living with supportive 

services (including Shelter Plus Care units). 

In the early 1990s, DESC also began to develop housing programs for its clients in addition to 

emergency shelter already provided. It now operates emergency shelter, save haven housing, and 

permanent supportive housing. Like CPC and DESC, a number of other mental health agencies 

began to develop housing, but have since stopped this practice. Mental health agencies are being 

forced to deal with cutbacks and new Medicaid eligibility rules that make it difficult for them to 

even provide outpatient care, their primary service function. Consequently, CPC and DESC are 

currently the only mental health treatment programs in Seattle that have continued to develop 

new housing programs for homeless and chronically homeless clients. Other agencies still 

operate projects they developed previously, although a number of those projects and hundreds of 

beds have been lost to the system since the mid 1990s probably contributing to rising street 

counts 

Plymouth Housing Group organized in the early 1980s to provide stable, safe, affordable housing 

for homeless and very low-income individuals. Support services were introduced in PHG 

housing in 1996/1997. Before this time, the average stay at PHG was 18 months, but since 

supportive services have been introduced the average stay has increased to 36-38 months. PHG 

does not require that individuals be clean and sober but they must be able to follow associated 

housing rules. PHG staff link tenants with relevant community resources. PHG also administers 

the Shelter Plus Care program for the King County Department of Community and Human 

Services. 

A Federal funding opportunity had an important impact on Seattle's programs for the chronically 

street homeless population. In 1993, King County applied for and became a site in the 

Department of Health and Human Services, Substance Abuse and Mental Health Services 

Administration's Access to Community Care and Effective Services and Support (ACCESS) 

demonstration project. The Seattle sub-sites for the project were CPC and DESC. This ftve-year 

project was a signiftcant event in Seattle's development of outreach and engagement services for 

chronic street homeless individuals. The project undertook assertive outreach, found new pockets 

of homelessness, and helped chronic street homeless persons through the eligibility process for 

health and human services. It helped spark system innovations in Seattle and King County 

services, such as the merger of the mental health and chemical dependency divisions of county 

government and adding a housing specialist to this staff (now called the Mental Health, 

Chemical Abuse, and Dependency Services Division, King County Department of Community 

G.4 
Appendix G: Seattle 

and Human Services). The demonstration persuaded the county government that programs such 

as those operated through ACCESS were saving money that would have been spent on back-end 

services such as jail and hospital costs. As a result of the success of the ACCESS project, King 

County continues to pay for outreach and engagement services through DESC in the form of the 

HOST Project, described below. 

The Continuum ofCare Plan 

To ensure that services funded by the McKinney-Vento Homeless Assistance Act were not 

leaving gaps, HUD in the 1990s began requiring communities to submit comprehensive 

applications for competitive funds, rather than individual programs submitting applications. In 

response Seattle, King County, service providers, clients, business associations, and community 

organizations worked together for two years on the Seattle-King County Continuum of Care Plan 

adopted in the spring of 1996. These community components already interacted on numerous 

homelessness issues. However, the new McKinney-Vento requirements structured more 

comprehensive planning. The CoC process did not focus specifically on the chronically street 

homeless population. However, the agencies providing such services were already being funded 

and continue to be part of the application. The City of Seattle Human Services Department and 

King County Department of Community and Human Services continue to jointly share the 

responsibility of developing and submitting the consolidated application for McKinney 

assistance. 

Approach to Chronic Street Homelessness 

Although Seattle does not have one authority responsi-ble for addressing chronic homelessness, 

over time the region has developed an approach to this population as homeless service providers, 

low income housing providers, and other agencies involved with this population have cultivated 

working relationships and have capitalized on Federal and local funding opportunities to expand 

programming. There is no city wide coordinated entity that controls and manages the full 

spectrum of resources and services targeting chronic homelessness. Instead, individual nonprofit 

service providers and government agencies have taken it upon themselves to tackle the problem 

of chronic street homelessness through specialized service offerings. Some of these agencies 

work together to meet the needs of their clients while others operate service structures 

representing the full continuum of care under their own umbrella. Local government leadersprimarily from Seattle and King County-have sponsored various coalitions and task forces over 

the years that have brought these agencies together to analyze needs, establish priorities, and plan 

for specific projects and system improvements. Seattle has also responded to Federal funding 

guidelines concerning programming strategy and initiatives to reduce chronic street 

homelessness. 

On our visit to Seattle on March 18-21,2003, we interviewed 44 people. They represented city 

and county agencies; nonprofit service agencies operating outreach, drop-in, shelter, and housing 

programs; agencies serving homeless people through case management, mental health and 

substance abuse treatment, and health care; and advocacy organizations. People who had 

experienced chronic street homelessness were included in a separate focus group. A full listing 

G.5 
Appendix G: Seattle 

of persons interviewed, other than focus group participants, may be found in at the end of this 

appendix. In addition to the site visit meetings, we gathered information from phone interviews 

before and after the visit, written material from the programs, newspaper articles, agency 

web sites and the SeattlelKing County Continuum of Care (CoC) application. 

Agency Interactions at the City and County Level 

As already noted, Seattle does not have a regional, systematic coordinating body to manage 

resources and orchestrate a service approach specifically for the chronically street homeless 

population or to create a pipeline for expanding permanent supportive housing. Instead, Seattle 

has several interagency planning groups and organizing bodies, only one of which has an 

important focus on chronic street homeless persons. These include: 

• 	 The Chronic Populations Action Council (CPAC) (previously the Systems Integration 

Advisory Committee and originally called the Systems Design Work Group) was formed 

originally as part of Seattle's Federally funded, five-year ACCESS demonstration project 

to focus on system issues related to homeless mentally ill people. At the same time, a 

Chronic Public Inebriates workgroup was developed at the request of the county 

executive to address concerns around this subset of the homeless population, and 

developed and action plan to create appropriate services and housing. When the mental 

health and chemical dependency divisions of county government merged in 1998, the two 

groups also merged. In late 2002, the group was renamed CPAC. The original two groups 

and, now the united group, pushed with ultimate success to develop a number of 

specialized services for the chronically street homeless popUlation. These include the 

Harborview Medical Center Crisis Triage Unit, the Mental Health Court, the Dutch 

Shisler Sobering Center, the REACH Project, the mental health detoxification 

enhancement project, the Emergency Service Patrol, and consumer-choice housing 

projects such as the Archdiocesan Housing Authority's Wintonia project and the DESC's 

1811 project (described below). The Council meets monthly to exchange information 

among government and private service providers, homeless persons advocacy groups, 

and business representatives. The Council continues to work toward goals laid out in the 

plan created by the original ACCESS Systems Design Work Group and the Chronic 

Public Inebriates workgroup as well as other projects. Although not exclusively focused 

on street homeless issues, the Council, and its previous iterations, has clearly increased 

services and promoted systems integration for this population and continues to have a 

major focus on this issue. 

• 	 The Downtown Seattle Association, a local business association focused on downtown 

business community concerns including social service policy, provides leadership in the 

area of chronic street homelessness. This group helps gamer support from neighbors and 

improve community relations for projects serving this population. Specifically, it 

supports DESC's work and has been instrumental in the development of the new 

consumer choice housing project being designed by DESC. 

• 	 The SeattlelKing County Coalition for the Homeless, which addresses issues concerning 

all types of homeless persons, also meets monthly and has subcommittees that meet as 

G.6 
Appendix G: Seattle 

needed, often weekly. Founded in 1974 in partnership with the City of Seattle and King 

County, the Coalition is the community's oldest and strongest organizing force on 

homelessness issues. It is part of the Washington State Coalition for the Homeless that 

meets quarterly and has two representatives on the King County Committee to End 

Homelessness (CEH). Despite its considerable work on homelessness issues, it does not 

have a specific focus on chronic street homelessness. 

• 	 The McKinney Steering Committee includes representatives of service providers, local 

government, and the United Way, and since 1997 has provided policy guidance on 

Continuum of Care planning and application processes. It seeks broader community input 

through broad-based meetings of stakeholders known as the Seattle-King County 

Advisory Committee on Homelessness (ACH). The ACH grew out of an earlier 

homelessness advisory group that developed a Continuum of Care plan in 1998. The City 

of Seattle and King County jointly convene and staff these groups. 

• 	 HCH Network Planning Council, housed in the Department of Public Health, is an 18­

member community-based advisory group that conducts planning and program 

development for homeless health services countywide. About 65 percent of program 

resources are targeted to single adults, and it oversees REACH case management project, 

a Medical Respite program targeting chronically homeless, and the provision of shelterbased nursing and mental health staff in downtown Seattle shelters. 

• 	 HIV/AIDS Planning Council (not exclusively focused on homeless, but has been 

instrumental in launching housing and services for chronically home"less people with 

AIDS (e.g., the Lyon Building) 

Of note is the high degree of cross-membership among these groups; many of the same 

individuals and organizations are represented across these and related coordination groups, 

essentially forming an informal communication and coordination network among the City of 

Seattle, King County I\.1HCADS, Public Health, housing organizations, and service providers. 

Agency Interaction at the Case Level 

Seattle agencies face a challenge in moving interagency awareness, coordination, and 

collaboration from the level of systems coordination and general program activities to case 

management and services. The broadest programs are umbrella agencies offering minicontinuums that can and do provide care for clients without involving other agencies. Clients can 

benefit by having "one stop shopping" and simpler interactions with providers that help to avoid 

gaps in service. This vertical approach, however, may lead to inefficient duplication of services 

and needless competition. For example, other than the data provided within the Mental Health 

Information System and the HCH Network database, currently no central integrated case 

management database exists through which one agency can tell whether a client also receives 

case management services from another agency. When agency staff members discover 

overlapping case management, they often reconnect clients to the original service provider. But 

currently no central database lets staff members look up the services that someone is receiving 

across agencies in different systems. 

G.7 
Appendix G: Seattle 

Some instances of coordination and collaboration do exist at the case level. Seattle uses a tiered 

system for mental health services that is coded into a Mental Health Information System-the 

county mental health database. Individuals have a record in the shared database and get a rating, 

or tier, for their service needs. A person must fIrst be on or eligible for Medicaid then the agency 

serving the client will apply for a tier for the client based on medical necessity and treatment 

intensity. The county will review the tier request and grant or deny the tier. Once tiered, the 

person can begin to receive ongoing publicly funded treatment. The database also logs the 

agencies that provide care within the mental health system; two agencies cannot serve the same 

individual and both receive reimbursement for their care. As a result, this database prevents 

mental health service duplication and encourages some service coordination. If, for example, the 

DESC's HOST team begins to provide outreach and engagement services to an individual who 

already gets services from another agency, the HOST staff will reconnect the person to the 

original agency to continue services. Or if the person seems to need the specifIc services HOST 

has to offer, HOST staff will contact the other agency and ask them to stop providing services to 

the individual so HOST can provide services. 

The Mental Health Information System also provides opportunity for coordinating services with 

local hospitals and jails. Once a person is logged in the database, a countywide agreement 

assures that local jails and hospitals notify the mental health provider if its client becomes 

incarcerated or is admitted for services. Then the mental health provider is encouraged to contact 

the client to re-establish or refine service linkages. Some mental health workers reported that 

they wait a day or so, depending on the circumstances, before visiting a client in jailor the 

hospital so the person has some time drug-free along with regular food and sleep. Waiting makes 

it easier for providers to engage clients in services. 

Another collaborative effort at the case level is multi-agency teaming to address the needs of 

homeless people who use a lot of crises services. The REACH Project and Crisis Triage Unit 

organize case teaming of relevant service providers to develop a case plan designed to stabilize 

housing and other issues for these people who use extensive public resources. Agencies attending 

the meetings commit to carrying out their part of the case plan, and follow-up assures that the 

promised services actually happen. These approaches are described further below. 

Selected System Components 

Seattle's service system for the chronically street homeless population includes most of the usual 

CoC components. The programs reside within individual agencies, some of which offer only a 

single aspect of the CoC while others offer many interconnected services under the auspices of 

one agency. We refer to the later arrangement as a vertical approach or a mini-continuum. Table 

G.1 presents an overview of the agencies involved, showing the type of programs and services 

each agency offers the chronically street homeless population.41 Rows represent different 

providers; columns represent the types of programs and services offered. An "X" in a cell 

indicates that the provider offers that program or service. An "F" indicates that a public agency 

41 Table 0.1 does not represent the entire network of homeless assistance programs and services in Seattle. These 

and other providers may also offer programs and services for other single adults who are homeless (but not 

chronically so), homeless families with children, and homeless youth. 

0 .8 
Appendix G: Seattle 

funds a program or service, and an "E" indicates that the provider offers expert advice, technical 

assistance, or training. Seattle's approach to chronic street homelessness is described below by 

service type. The programs either have an exclusive focus on chronically street homeless 

individuals or some portions of their services address the needs of such individuals. 

DESC and CPC, both private non-profit organizations, are the two providers with the most 

comprehensive services for the chronic street homeless population. They each have a wide range 

of housing resources that enables them to shelter individuals as they move from street 

homelessness to permanent housing. DESC and CPC both provide substance abuse and mental 

health services through their licensed programs and operate save havens, and DESC provides 

health services. They both provide case management and help their clients work with mainstream 

agencies. Although CPC does not operate emergency shelter, it does provide emergency housing 

options. Both programs work around gaps in the system and keep their clients as they move 

between levels of care. 

Other broad range housing developers and service providers are AIDS Housing of Washington 

(AHW), the Archdiocesan Housing Authority (AHA), and Plymouth Housing Group. These 

agencies manage a wide range of housing and help their clients receive other supportive services 

through mainstream agencies. Of the mini-continuum agencies, DESC is the only one that has an 

exclusive focus on chronic street homeless people. 

Prevention 

Providing housing alternatives to living on the street is an essential part of preventing 

homelessness. Seattle is creating more housing for persons who are homeless or at risk of 

becoming homeless, but not enough and not fast enough to keep up with the demand. We discuss 

these efforts below under Affordable Housing. 

Outreach and Drop-in 

The four outreach and drop-in programs in Seattle significantly focused on chronically street 

homeless are the Mental Health Chaplaincy, REACH Project, HOST Project and Angeline's Day 

Center. Other outreach and drop-in programs are Operation Night Watch, the Women's Referral 

Center, the Chief Seattle Club, Lazarus Day Center, and the Compass Center. 

Mental Health Chaplaincy. The Mental Health Chaplaincy is an outreach and engagement 

program for the most difficult and most vulnerable mentally ill street homeless people. Its 

outreach strategy involves long-term engagement with clients until they receive benefits and are 

comfortable moving into services and/or housing. Because the system can be fragmented and 

clients often are involved with numerous agencies, people can fall out of the system. The 

Chaplaincy's approach is meant to be a source of consistency for homeless people until they are 

stabilized. Also, Chaplaincy staff members provide training to other agencies in the community 

and maintain particularly strong ties to faith-based communities and organizations. 

G.9 
Appendix G: Seattle 

Table G.1: City of Seattle: Agencies Involved in Reducing/Ending Chronic Street Homel

Homeless-Related and Services 

Nonprofit Programl Servicesl Agencies 

Serving Currently or Formerly Chronic Street Homeless People (listed 

alphabetically) 

AIDS Housing of Washington X I X I X X X TA 
Archdiocesan Housing Authority XIX X I X I X I X X X X X 

Wintonia Housing X I X I X X X X Westlake Housing X I X I X X X X X 

Lazarus Day Center X 


Noel House X 


Josephinum House X X 


Dorothey Day House X X 


Women's Referral Center X 


Chief Seattle Club X 


City of Seattle 


Human Services Department FIFIFIFIFIFI FIFIFIFIF X X 


Office of Housing F I F I F X 


Community Psychiatric Clinic X XIXIX XIX XIX XIX X X X I X I 

Residential Treatment X X X 


Harbor House X XIX X 


Emergency Respite X XIX X 


Publicly Funded Mental Health X XIX X 


Supported Living X XIX X 


Independent Living X XIX X 


Compass Center X X 


Downtown Emergency Service Center XIXIX XIXIXIXIX X X X X 

G.10 
Appendix G: Seattle 

Table G.1: (Continued) 

HOST Project 


DrClfCin Center 


Emergency Shelter 


Kerner Scott House 
Morrison Building 


Lyon Building 


Union Hotel 


Dutch Shisler Sobering Center 

Evergreen Treatment Services - REACH Project 

Harborview Medical Center Crisis Triage 

Unit 

Harborview Mental Health 

Healthcare for the Homeless Network ­Department of Public Health / Seattle and 

King County 

King County Department of Community 

and Human Services 

Community and Human 

Services Division 

Mental Health , Chemical 

Abuse, and Dependency 

Services Division 

Emergency Service Patrol 

Mental Health Chaplaincy 

Operation Night Watch 

Plymouth Housing 

Coming Home Program 

Veterans Affairs -

Healthcare for the Homeless 

William Booth Center 

YWCA - Angeline's Day Center 

x = Provider 

x I I X I X X 
x x 


X x X 


x x X X 


x X X X 
x X X X 


X X X X 


X X 
X X X X 

X X X X X 

X X X X X X X 

X,F x, FIX, FIX, F X F X X

F I F I F I F F F F I F I F F F X 

X, FI F X 

X X 


XIX X X 

X 


X X X X X X 

X x 


X X 


x X 


X I X I X X x X X X I X 

TA = Expert TA Provider F = Funder 


G.ll 
Appendix G: Seattle 

The Chaplaincy program helped to develop and uses the Relational Outreach and Engagement 

Model currently promulgated by the National Health Care for the Homeless-Council.42 This 

model has four phases to working with homeless individuals: approach, companionship, 

partnership, and mutuality, which revolve around building and shaping a relationship with the 

client. The focus is to build trust with a person and become that person's companion before 

pushing him or her into services and programs. The process helps people evolve until they are 

ready to access services on their own terms. This type of connection may be missing in other 

service contacts and it may be the hook that helps move people to services, assists them in 

trusting the service providers, and gets them off the streets. ill practice, the outreach workers 

spend time with homeless people on the street, becoming part of their everyday experience, 

becoming familiar, and offering companionship. The Mental Health Chaplaincy typically works 

with Harborview Mental Health, local emergency rooms, DESC, and the HCH Network. 

REACH Project. The REACH Project is an outreach and long-term engagement strategy for 

chronically homeless public inebriates using a harm reduction model. REACH is a project of the 

Department of Public Health's HCH Network, and involves two agencies. Project leadership and 

case management staff members are provided by Evergreen Treatment Services. A full-time 

registered nurse is also part of the team, contracted through Pike Market Medical Clinic. All 

REACH staff members, both the case managers and the nurse, are sited at the Dutch Shisler 

Sobering Support Center. REACH case managers work with clients to develop relationships and 

address basic health and housing needs. They have direct access to and control of Shelter Plus 

Care housing vouchers. 

This Sobering Center is managed overall by the King County Department of Community and 

Human Services, which partners with part of the Recovery Centers of King County to operate 

sobering services as well as outpatient centers and county detoxification programs. Working with 

staff from a number of county and city departments, the King County Executive's Office 

conceived of and helped develop the Sobering Center. 

HOST Project. DESC runs the HOST Project. Outreach and Engagement Specialists work 

within specific geographic regions or in other targeted programs or facilities such as drop-in 

centers for women, local hospitals, and jails to fmd chronically street homeless people. 

Sometimes they approach potential clients directly and other times they develop an engagement 

plan with staff members from other agencies who have had interactions with the person. HOST 

staff members receive referrals from concerned citizens, jail, the Department of Social and 

Health Services (DSHS), the mental health court, hospitals, the Harborview Medical Center 

Crisis Triage Unit, the Seattle Public Library, family members, and other mental health 

professionals, shelters, and drop-in centers. 

HOST also connects to people through other DESC services. DESC shelter staff members refer 

clients and provide information based on the large amount of time spent with shelter users. 

DESC also runs a drop-in center on weekday mornings offering hygiene and storage facilities 

and a place to relax, eat, play games, read, watch television, and/or use computers. HOST staff 

members often see the same individuals many times in a given day or week. Drop-in center visits 

42 The curriculum can be found at: http://www.nhchc.orgiCurriculumlindex.htm. 

0.12 
Appendix G: Seattle 

are another opportunity for staff members to engage vulnerable individuals. Whether based on a 

referral or directly approaching someone, HOST workers target the very vulnerable people who 

have not been successful in other service settings. 

HOST staff members use a number of engagement strategies with individuals when they 

approach them directly on the street. Although staff members do not deny their agency 

connection when asked, they do not introduce themselves as mental health or outreach workers. 

They try first to engage people in "small talk." The workers try to meet people where they are 

comfortable. One strategy is to know where a particular person spends most of herlhis time and 

then to also spend time in that area. It is helpful when a homeless person recognizes the HOST 

worker as a familiar face in the neighborhood. Homeless persons seem to be less threatened 

when -the staff person is part of their world. 

A second strategy is to offer people on the street tangible items such as coffee, clothes, or 

sleeping bags as an immediate way to make a connection. Once tangible items are accepted, the 

staff members also offer their time to help the homeless person get benefits, medical care, or 

other needed services, including attending appointments with clients. Disabled homeless 

individuals may not have the patience to wait for an appointment, but if someone is with them 

they are more inclined to stay until they receive the attention they need. 

A third strategy is to offer the services of the drop-in center, including its storage space. Staff 

members reported that storage is a big draw to the drop-in center. Homeless individuals are 

always asked to move along on the street and it is difficult to move with their belongings. The 

storage space allows people to know their belongings are secured. A fourth strategy used once a 

person is engaged in some services is to start working on housing options. Outreach staff may 

make a referral to the safe haven program run by DESC long before the homeless person is ready 

to accept that offer, so a part of the waiting period has passed when the person is ready to go. 

Outreach and engagement staff members report that individuals vary widely in the time it takes 

before they are receptive to help. While most homeless persons come in off the street in a matter 

of weeks or months, for some the outreach process requires years. Each staff member typically 

sees five or six people very regularly and others on their caseload one time per month. 

Angeline's Day Center. In 1986, the Seattle YWCA opened Angeline's Day Center for 

chronically street homeless women. The center's mission is to provide women with basic 

survival services and a safe place to be. The center is a low-barrier, harm reduction environment 

that women can frequent as long as they are not violent or abusive. It is designed for 78 women 

per day but actually serves 150-250 women daily and served a total of 1,371 different women in 

2002. The YWCA does not actively do outreach because most women fmd Angeline's through 

word-of-mouth on the street or through referrals from the police, hospitals, and the crisis line. 

Despite not having strategic outreach activities, the YWCA estimates it reaches about 90 percent 

of chronically street homeless women in Seattle through the center's services. 

The center meets basic needs such as hygiene, three meals a day, and information and referral to 

other agencies as well as having mental health specialists and nursing staff on site as part of the 

HCH Network. It hosts Alcoholics Anonymous meetings on site and brings in other substance 

abuse treatment agencies for services and referral. Additionally, a housing resource group helps 

G.l3 
Appendix G: Seattle 

women fill out applications for housing if they are appropriate for particular settings. Angeline's 

staff members connect with case managers from numerous programs so they know who to 

contact if problems arise. If a woman does not have a case manager from any service provider, 

the staff will connect them to a program that meets their specific barriers and cultural needs. 

Emergency Shelters Focused on the Chronic Street Homeless Population 

As shown in Table G.l, Seattle ha-s several agencies providing emergency shelter for the chronic 

street homeless population. However, three are especially significant for giving their clients a 

broad range of services: DESC's 24-Hour Emergency Shelter, Harborview Medical Center Crisis 

Triage Unit, and Angeline's Day Center. 

DESC's 24-Hour Emergency Shelter. Among its programs, DESC operates a 24-hour 

emergency shelter that serves about 8,000 people annually. An on-site nurse-funded by the 

HCH Network and provided by Harborview Medical Center's Pioneer Square Clinic-provides 

medical services and a HOST staff member works in the shelter to provide engagement and case 

management services. 

Harborview Medical Center Crisis Triage Unit. The Harborview Medical Center Crisis Triage 

Unit was created to divert people from law enforcement interventions and psychiatric 

hospitalizations, and although it maintains a "no refusal" admissions policy, has developed 

specialized services for people who are too drunk for detoxification and too violent for jail. The 

unit provides crisis stabilization services and medical care for a maximum of 24 hours. It 

provides a single point of entry to many service systems and screens for and links clients to 

mental health, substance abuse, and disability services. 

The unit has 13 beds-8 single rooms and 5 beds in an observation room in the emergency 

department of the Harborview Medical Center. The unit receives referrals from a number of 

sources: equal proportions are walk-ins, from law enforcement, and referred by family and other 

community members. The unit handled 8,000 visits in 2002 and expects to see more in 2003. 

Twenty-eight percent of the people served are homeless. 

Each client works with a nurse, a medical assistant, a psychiatric nurse, and a liaison social 

worker. The social worker provides information and referral to other community agencies and 

resources. Although the triage unit functions in part as a diversion strategy, because of the acuity 

of so many of the individuals referred to the triage, about one-third of its clients end up 

hospitalized (about half voluntarily). Other clients are referred and formally linked to other 

mental health and chemical dependency services such as Harborview Mental Health and DESC. 

"Back door" staff members, including certified mental health and chemical dependency 

specialists, are utilized to follow up on referrals and promote effective service connections for 

individuals leaving triage. These staff members are critical to the diversion process, and help to 

reduce Crisis Triage Unit recidivism. 

Changes in fmancial resources (King County is reducing the unit's funding by about $800,000) 

are forcing changes in the service model from an integrated to a more medically oriented model. 

This will allow them to bill MedicaidlMedicare and will bring a psychiatric physician into the 

unit 24 hours a day. 

G.14 
Appendix G: Seattle 

Angeline's Day Center. The YWCA's Angeline's Day Center allows 30 women a night to sleep 

in the center. These women are referred from the AHA women's shelter, where AHA and 

YWCA staff members work together to identify women that AHA cannot serve for the night and 

send them over to Angeline's. 

The Seattle YWCA has a major focus on services for women who are homeless. Thirty-eight 

percent of their $19 million budget is devoted to such services. This year they implemented a 

capita~ campaign and raised $43 million to expand the Angeline's Day Center to create 

Opportunity Place. It will include all the current services at Angeline's described above, but will 

also co-locate 14 other agencies for mental and physical health services ~ employment and 

education services, and other resources. Additionally, 145 low-income Section 8 housing units 

will be built on the upper floors of the building. 

The Medical Respite Program provides short-term nursing and recuperative care for 

chronically homeless clients with an acute medical diagnosis. Respite staff use the opportunity 

provided by daily contact with clients in a safe and structured setting to provide psychosocial 

assessments and case management services to link clients with housing, on-going primary 

medical care, substance abuse and mental health treatment and other needed services. The 

program has the following objectives: 1) resolve presenting medical problems; 2) provide 

psychosocial evaluation as needed and appropriate referrals in the area of housing status, 

entitlements, physical health, mental health and substance abuse; and 3) initiate the process of 

housing stabilization. 

The Respite Program is a collaborative project between HCH Network and Pioneer Square 

Clinic (a satellite clinic of Harborview Medical Center). HCH contracts with two local shelters to 

provide shelter, case management, food, and laundry services. Seventeen beds for men are 

located in the William Booth Center (Salvation Anny shelter) and five women's beds are located 

at the YWCA. Respite services are offered 7 days a week. The shelters provide non-clinical staff 

24 hours per day. Both shelters provide emergency and transitional housing available to 

appropriate clients after discharge from the respite program. 

From July 1997 through December 2002, Medical Respite served 1,717 unduplicated clients. 

The program averages 400 admissions per year; all are homeless single adults. The clients have 

long histories of homelessness, and 75 percent have mental illness and/or substance abuse 

problems. Of note is that 40 percent lived on the street prior to on Respite, making this a program 

that works with a particularly high number of street homeless. The time spent is Respite in a 

window of opportunity to work with this highly disabled street popUlation in order to promote 

housing stabilization. 

Safe Havens and Low Demand Residences 

Seattle has two programs providing safe haven or very low demand type residences-Harbor 

House and Kerner Scott House. 

0 .15 
Appendix G: Seattle 

Harbor House. CPC, runs Harbor House a transitional housing program using a safe haven 

model. CPC partnered with Federal, state, county, and city governments to build the facility in 

which both Harbor House and the Dutch Shisler Sobering Support Center are located. 

Kerner Scott House. DESC runs the Kerner Scott House, a 40-bed program using a safe haven 

approach. DESC workers reported that a number of clients need a safe haven/low demand 

environment rather than emergency housing as their fIrst step off the street. Shelters are often 

crowded and noisy, and the homeless person may not feel comfortable and safe in that 

environment. The Kerner Scott House employs a low demand harm reduction model. DESC staff 

members have found that people are better able to address their problems when they are in stable 

housing. There are no requirements to be eligible for residency and the staff is very flexible in 

allowing clients to do what they need. For example, a woman was not comfortable going to her 

room so the staff allowed her to sit in a chair in the hall for months until she was ready to move 

to her room. If a person is still using heroin, the staff treat it as a clinical issue rather than a 

criminal justice issue as long as the person is not using inside the facility. A person may remain 

in Kerner Scott as long as necessary until permanent housing is available. Program data show 

that nearly half (48 percent) of residents of Kerner Scott remain in the program for 12 months 

and 23 percent remain for 24 months. 

Case Management 

Seattle has three case management approaches that are especially noteworthy-a multi-agency 

team for high users of crisis public services; the Dutch Shisler Sobering Support Center; and 

HOST Intensive Case Management. 

Multi-agency Teaming for High Users of Crisis Public Services. An important component of 

the Crisis Triage Unit program is an effort coordinated with other service providers to address 

the needs of the most vulnerable clients. Every two weeks staff members from the Triage Unit, 

REACH, the emergency room, the Sobering Center, the detoxifIcation center, the Emergency 

Service Patrol and other relevant service providers meet to discuss high service users. These are 

people who have used the Triage Unit four times in three months; 52 percent are homeless. 

Together the agencies create plans for clients that each provider commits to following. This 

system allows service providers to think together creatively about client needs and the types of 

services that would be helpful to particular individuals. Clients sign information releases so 

agencies can coordinate in this way. At times the Triage Unit may also involve the client, family, 

friends, or police representatives. Together with the health and social service agencies, they 

decide what is missing to stabilize the person and come up with a plan that everyone commits to 

implementing. 

Dutch Shisler Sobering Support Center. The Sobering Support Center was built and is owned 

by CPC and co-locates three connected programs collaborating to provide services for chronic 

public inebriates-the Sobering Support Center itself, the Emergency Service Patrol, and the 

REACH Project. The Sobering Support Center, part of the Recovery Centers of King County, 

cares for people as they sober up. Clients arrive at the Sobering Support Center either by referral 

from concerned citizens or through the Emergency Service Patrol. Clients are able to sleep off 

their binge at the Sobering Support Center as well as store their belongings in available storage 

G.16 
Appendix G: Seattle 

space. Staff members check vital signs every few hours and a nurse case manager provides 

medical servic.es. Sobering Support Center staff members refer clients to REACH for case 

management. 

The Emergency Service Patrol, a King County program, is a van service that picks vulnerable 

homeless people up from the streets and brings them to the Sobering Support Center or to other 

service providers as needed. 

REACH Project staff members receive referrals from the Sobering Center or conduct outreach in 

the Center or on the street. Clients must use the sobering center to be eligible for REACH's 

intensive case management. REACH staff members target the most vulnerable and difficult to 

serve, who are likely to make heavy use of the Sobering Center. Services target client-defined 

goals, focusing clients on engaging and building relationships. Most of the clients want survival 

services, most of which are provided on the street. REACH has eight case managers each with a 

caseload of about 20 people. 

Early contacts involve screening clients to be sure they are not using other service providers or to 

determine whether other service providers would better suit their needs. Because REACH 

focuses on alcohol abuse, workers try to refer homeless people with other issues as their primary 

problem to appropriate services. lEthe person is appropriate for REACH services, staff members 

complete a second assessment and sent it to the HCH information system. From that point staff 

members connect their clients to many types of service as needed. Case managers spend an 

enormous amount of time with clients because they help make appointments and also accompany 

clients to ensure receipt of services. 

REACH has a positive relationship with the DSHS. It assists clients to apply to the state for 

Alcohol Drug Abuse Treatment and Support Act money, eligibility for which opens the door to 

all chemical dependency services in Seattle. This fund provides cash assistance to people who 

are disabled due to addiction as long as they are in treatment and have a payee. Establishing 

eligibility for these payments is extremely challenging because it requires four appointmentsthree screenings by different people and a fourth meeting for an assessment. About four weeks 

pass between initial screening and assessment, after which eligible clients are placed on a 

waiting list for services. Then clients must contact the program every day between 9:00 a.m. and 

noon to see if a bed is ready for them. REACH staff members report it is incredibly challenging 

to motivate an addicted homeless person to go through all the appointments and call every day 

once qualified. Also, the DSHS program has an employment focus, so individuals who will 

never be able to work regardless of sobriety may not get treatment. 

The REACH Project has positive relationships with housing providers, some of whom are more 

willing to take clients from REACH's case management rolls than other sources because the 

project is well respected. REACH staff members believe in harm reduction models because not 

everyone they serve is ready to accept treatment though they might accept housing. However, 

once clients are in housing and can value having that stability, they can begin to deal with the 

consequences of their drinking and other addictions. REACH controls 24 Shelter Plus Care beds, 

so its case managers can decide who goes into those slots. All other housing is accessed through 

other programs including the Wintonia (the Archdiocesan Housing Authority's consumer choice 

housing program), DESC, and others. The Wintonia is currently the only explicitly consumer0 .17 
Appendix G: Seattle 

choice housing in the Seattle area. However, DESC is currently trying to construct a new facility 

for the same purpose (the 1811 project). There are also abstinence-encouraged housing projects, 

such as Scott Kerner, which accept residents who drink but do not permit drink.i.ng on the 

premises. Usually abstinence-encouraged projects enforce this restriction only when a resident 

presents a problem by drink.i.ng in the building'S common areas. 

The goal of the combined services of these three Sobering Support Center programs is to reduce 

homeless persons' reliance on more expensive community services such as emergency rooms, 

detoxification, and the Crisis Triage Unit. 

HOST Intensive Case Management. DESC clients move from HOST outreach and engagement 

specialists to HOST intensive case managers when there is a natural transition point in the 

relationship_ Sometimes this happens soon after the specialist develops a relationship with the 

client and other times it could take months or even years to make the transition to intensive case 

management. Intensive case managers carry a caseload of about 12 to 15 people. The specialists 

try to match the type of client they have for transition to particular intensive case managers based 

on specific strengths and skills of the manager. Intensive case management should be 

temporary-a year or so-but in actuality it can operate for years depending on the needs of the 

clients. The goal is to move clients from intensive case management to long-term mental health 

and chemical dependency services either with DESC staff or other agencies in the community. 

The HOST team also offers clients a unique service-applying for benefits-through a contract 

with DSHS. Homeless clients may not want to go to the welfare agency but may want benefits. 

The HOST staff is able to complete the paperwork for them by contacting a specific person at 

DSHS assigned to this task. However, if HOST staffers try to use other eligibility workers, the 

process seems to fall through. In addition, a HOST staff person is out-stationed at the DSHS 

agency one day a week so eligibility workers can refer clients directly to HOST if necessary. 

Focus group participants reported that having a case manager was critical to their ability to get 

offthe streets and get the help they needed. They saw the case manager as the starting point to 

identifying resources they were not aware existed in the community. 

Permanent Supportive Housing 

Seattle has four substantial permanent supportive housing programs run by DESC, CPC, AHA, 

and PHG. 

Downtown Emergency Services Center. DESC maintains 321 units of permanent 

supportive housing in the Union Hotel, the Lyon Building, and the Morrison Building. All 

have 24-hour on-site clinical staff. DESC tries to create a seamless integration between the 

property management function in the buildings and the supportive services division, as staff 

members believe this approach yields a better connection between clients and workers and 

long-term success. The staff members, who usually have a social work background, are 

trained to handle both property management issues and supportive services. The philosophy is 

that it is easier to teach a social worker property management skills than the other way around. 

G.18 
Appendix G: Seattle 

DEse's permanent supportive housing embraces a harm reduction approach. This does not mean 

that problems and issues do not arise or that anything goes in DESe hollSing. Rather DEse staff 

has been trained to respond to issues differently than in the past to work out the resident's 

problems instead of using eviction as a response. Residents are still held accountable for their 

actions (often by fellow residents) and DEse staff members work with the resident to address 

their problems. 

A particularly important project is the Lyon Bui1ding, which was developed and is owned by 

AHW but operated by DESe. This building is specifically for HIV/AIDS individuals who also 

suffer from mental illness, substance abuse, or both. It is designed to assist multi-problem 

persons and is intended to be their permanent residence. DESe is' currently trying to develop 

permanent supportive consumer choice housing for chronic public inebriates and individuals 

with multiple barriers through its" 1811 Project" named after the site address. DESe has an 

agreement to set aside beds for persons dealing with both AIDS and addictions as part of the 

project and a Special Projects of National Significance (SPNS) grant from HUDIHOPWA has 

been awarded to DEse to support outreach and engagement efforts targeting this population. 

Community Psychiatric Clinic. epe has developed a mini-continuum of housing and services 

for homeless mentally ill clients. It maintains 276 24-hour supervised beds, 86 supported living 

beds, 132 independent living beds, 79 Shelter Plus eare beds, and 152 Section 8 beds. 

Historically a private nonprofit comprehensive behavioral health treatment center for people with 

severe mental illness and chemical dependency, epe has remained largely independent in 

developing housing. The housing tax levy funds (discussed in the funding section below) have 

been essential to th-e development ofepC's units and help leverage other funds when projects 

begin. epe has also worked with six churches in the area to develop housing. The churches 

purchase the housing and contract with epe to manage it. The rent subsidies from clients cover a 

portion of the mortgage costs. Of the three costs of operating supportive housing-capital costs 

to build or rehabilitate, operating costs, and service costs-capital is the easiest money to raise in 

Seattle and the service dollars are the most difficult to obtain. Typically, epe receives no city, 

Federal, or state funds for services when developing housing projects. Some homeless mentally 

ill persons can quality for Medicaid and county mental health services. 

epe housing clients usually come into services through its general intake department. In 2002, 

epe served 5,100 clients, 700 of whom were new (about that number leave its services each 

year). epe has staff co-located at the county hospital (Harborview), the community hospital, and 

the jail to screen people for mental illness and then offer services to qualified individuals. epe 

also receives referrals from hospitals, family members, and self-referrals. 

elient housing needs are addressed once they enter the epe system. In 2002 epe provided a 

total of206,501 bed days of which 121,456 were for persons who were homeless when they 

entered services. The remaining bed days were for persons who moved from a different level of 

care within the epe continuum of services. They too may have been homeless at one time. 

epe employs a harm reduction model in all its residential programs but does not explicitly 

operate consumer choice housing. epe is a licensed chemical dependency treatment provider in 

addition to its mental health services. Three epe houses are reserved specifically for recovering 

clients. If clients begin experiencing problems, epe moves them into different housing within 

G.19 
Appendix G: Seattle 

CPC, rather than releasing them to the streets. Although CPC does not technically "require" 

clients to use ser:vices (with the exception of the clients in the Shelter Plus Care beds), all of its 

clients receive Medicaid and have some sort of service strategy. CPC has United Way funding 

and raises private funding for the few clients who are not Medicaid beneficiaries. 

CPC's supported housing programs have specialized case managers on site. A client's case is 

transferred from the treatment program to the housing department for additional services. Staff 

members specially trained to provide housing supports and skills in daily living have lower 

caseloads. 

Archdiocesan Housing Authority. AHA has 650 units of permanent housing in downtown 

Seattle, in which residents have access to on-site services that use a variety of models of care to 

suit varying client needs. Although all AHA programs serve the homeless and low-income 

population, the ones that target the chronically street homeless population are the Wintonia and 

the Westlake. Not all the AHA programs require residents to be actively involved in services, but 

the Wintonia and Westlake do. Regardless of whether services are required, all the programs use 

a community-based approach, building a sense of community among residents to give people a 

feeling of connection to other residents and that the building is their home. 

The Wintonia includes 92 units of housing for chronically homeless individuals, 45 of which are 

reserved for people disabled by chronic alcoholism. It is currently the only explicitly consumer 

choice housing in Seattle. In this case, consumer choice housing means residents can use alcohol 

on site in their units but they cannot have guests while they are using or be intoxicated in the 

common areas of the building. (DESC's proposed 1811 project will have the same consumer 

choice housing rules.) Wintonia residents assigned to beds set aside for chronic inebriates must 

participate in chemical dependency services that DESC staff members deliver on site. An on-site 

resource coordinator works with residents in a case management capacity to help them access the 

services they need. 

The Wintonia receives referrals from the REACH Project, DESC, and substance abuse treatment 

facilities. The average length of stay at the Wintonia is three years, with two years as a critical 

point for self-sufficiency. If residents stay for 2 to 3 years they likely move on to more 

independent living situations (such as the AHA's Josepbinum House). If they leave before the 

two-year mark they are likely to be having problems and also have difficulty remaining in other 

housing. 

The Westlake has 53 units for men aged 55 and older who have been homeless at least one year, 

although many have been homeless much longer. As at the Wintonia, the Westlake has an on-site 

resource coordinator. Although the housing is not explicitly for chronic public inebriates, many 

of the residents struggle with this problem, so house rules regarding using alcohol are the same 

as those at the Wintonia. The Westlake receives referrals from REACH, DESC, the Plymouth 

Housing Group, its own day center, and the Compass day center. The average length of stay at 

the Westlake is 5.5 years. Some residents move to independent living and others move into 

nursing care because of their age and health status. 

Other AHA permanent housing programs may not be intended for chronically homeless 

individuals specifically, but this population may end up in the housing. For example, the women 

0.20 
Appendix 0: Seattle 

in the Dorothy Day House tend to be chronically homeless and the Josephinum House has 30 

Shelter Plus Care units. 

Plymouth Housing Group. PHO's mission is to provide stable, safe, affordable housing for 

homeless and very low-income individuals. PHO operates 11 buildings with 730 tenants. 

Although many of the tenants in PHO properties were chronically homeless and are disabled by 

mental illness and/or chemical dependence, this is not a requirement for PHO -housing. PHO 

operates a rental office and homeless resource center in downtown Seattle at which homeless and 

low-income people can apply for "one stop" housing. Through this rental office, PHO does preapplication screening for its own housing, AHA's housing, and the Low Income Housing 

Institute (LUll). Applicants can learn immediately which housing programs they qualify for. 

PHO workers link tenants with relevant community resources. PHO has documented the 

importance of providing support services to the residents in the population it serves. PHO started 

the Support Services Division of the agency in 1996. Before the agency provided support 

services to their residents the average length of stay in housing was 18 months. Since the agency 

began providing support services to residents the average length of stay has increased to 36 to 38 

months. 

PHO has a specific focus on the chronically street homeless population through its Coming 

Home program. PHO's Coming Home program involves six months of intensive services to 

formerly street homeless individuals who are moving into permanent housing. Tenants receive 

one-on-one support from housing stabilization workers to help them learn life skills, many of 

which they may never have learned before. Coming Home serves approximately 140-170 single 

individuals at a time, primarily between the ages of 31 and 50. Thirty percent of the participants 

have a mental illness and 25 percent are dealing with substance abuse issues. Although it is not 

clear how long the participants were homeless before starting the program, 19 percent were on 

the street the week before starting, 49 percent were in emergency shelter, 16 percent were in 

transitional housing, 12 percent lived with relatives or friends, 2 percent were in rental housing, 1 

percent were in psychiatric facilities, and 1 percent were in substance abuse treatment facilities. 

Almost all of the participants completed the intensive services and "graduated" from the program 

into permanent housing. 

PHO operates from a harm reduction/abstinence encouraged model; tenants have no requirement 

to be in treatment or working toward recovery. The aim is for people to feel safe and secure in 

their own apartment. Staff members are equipped to assist a tenant in receiving treatment if the 

tenant is motivated to do so. 

PHO also administers the Shelter Plus Care program for the King County Department of 

Community and Human Services. Seattle has 512 Shelter Plus Care housing units operated 

through partnerships with 14 service agencies in the city. Each agency has a housing point 

person who works with PHO to fill the Shelter Plus Care units. Waiting time to obtain a unit 

ranges from 3 to 18 months depending on the agency. Shelter Plus Care in Seattle supports 

persons in several PSH venues from SROs to private market apartments. The program offers 

subsidized housing in private markets, low income housing properties, or group home settings as 

well as case management, employment, mental health, and chemical dependency services. 

Services are provided with a harm reduction approach. Four of the agencies operating Shelter 

G_21 
Appendix G: Seattle 

Plus Care units (the Sobering Center, DESC, the REACH Project, and Harborview Mental 

Health Services) have a particular focus on the chronic street homeless population, which they 

define as having been homeless for two years or more during which they spent substantial time 

on the street and are challenged by disabilities. Other agencies in the Shelter Plus Care program 

provide pennanent housing for homeless individuals with disabilities (such as mental illness, 

chronic substance abuse and/or HIV / AIDS) and these individuals mayor may not have been 

chronically homeless on the street. 

Shelter Plus Care tenants must participate in intensive case management services as a Federal 

requirement attached to the housing subsidy. In addition to-regular meetings, case managers 

conduct at least four home visits in the first year of client participation and more as necessary. 

The case managers connect clients to whatever community resources they need and have the 

ability to move people to more independent housing or more intensive housing as the need arises. 

After the first year, clients are expected to have at least two contacts with their case managers 

annually. The program experiences about a 20 percent turnover every year, among which 10 

percent did not succeed in the program and another 10 percent moved on to independent living 

(no supportive services) with or without a housing subsidy. 

A Shelter Plus Care Coordinating Committee guides the Shelter Plus Care program; the 

Committee includes representatives from PHG and the 14 partner agencies, the King County 

Mental Health, Chemical Abuse, and Dependency Services Division, and King County Housing 

and Community Development Program. The committee members represent a broad range of 

homeless services to allow for flexibility in programming. 

Supportive Services 

Seattle-King County Health Care for the Homeless Network. The Seattle-King County HCH 

Network is part of the Department of Public Health, Seattle and King County, Community 

Health Services Division. The network was one of the original HCH grantees funded by the 

Robert Wood Johnson Foundation. It contracts with various agencies and service providers to 

offer a comprehensive health service approach to meet the varying needs of chronic street 

homeless people as well as other homeless populations. The four primary contract agencies 

serving the chronic street homeless people are the Pioneer Square Clinic (owned and operated by 

Harborview Medical Center), Evergreen Treatment Services, Pike Market Medical Clinic, and 

the Seattle Indian Health Board. 

Pioneer Square Clinic's main service site is its outpatient clinic on Third Avenue, a few blocks 

from DESC in the south end of downtown. Pioneer Square Clinic also operates a small clinic site 

co-located with the Public Health Needle Exchange program (known as Second Avenue Clinic), 

targeting chronically homeless intravenous drug users. Pioneer Square Clinic offers nursing 

services, mental health, and substance abuse services at a number of downtown shelter locations 

(such as DESC and Angeline's Day Center). Pioneer Square Clinic's HCH -funded mental 

health/substance abuse staffform a "Downtown Mental Health Team" which also takes referrals 

from a range of shelters and programs (such as Mental Health Court), and serves those clients 

that entities like DESC and CPC cannot serve because the clients are not eligible for Medicaid. 

HCH's Mental Health Team coordinates closely with the community-based mental health 

G.22 
Appendix G: Seattle 

agencies, referring clients to them who appear to be eligible for the publicly funded mental 

health system. As the mental health system tightens its eligibility requirements, HCH staff 

members find it more difficult to transition clients to the community-based system of mental 

health care. 

Evergreen Treatment Services also provides nursing care management to the REACH 

populations of chronic public inebriates through Registered Nurse services purchased from Pike 

Market Medical Clinic. Both services work through the Dutch Shisler Sobering Support Center. 

The Seattle Indian Health Board conducts outreach at the Chief Seattle Club and plays a major 

role in providing care to the Thunderbird Treatment Center. 

Community Clinics. The major community clinics working with the street population are 

Pioneer Square Clinic, Pike Market Medical Clinic, and Seattle Indian Health Board. Of these, 

Pioneer Square Clinic has a particularly strong focus on the serving homeless people and the 

chronically homeless. The clinic uses an "open access" -scheduling scheduling model to make it 

easy for clients to get same-day clinical services, and providers have a high level of expertise in 

working with the downtown homeless population who have acute and chronic conditions. 

Harborview Medical Center - provides urgent care, ambulatory clinics, Madison Clinic (for 

people with HIV / AIDS), dental clinic, and others. As the public hospital located a few blocks 

from downtown Seattle, Harborview Medical Center and its programs playa significant role in 

providing health services for the chronically homeless. 

Public Health. Seattle and King County provide an array of special health services that, while 

not designed uniquely for homeless people, playa key role in addressing major health issues and 

disabling conditions. These include coordination of an HIV / AIDS prevention and care system 

(including a Needle Exchange program), a Tuberculosis Clinic, and sexually transmitted disease 

clinic. A 2002 outbreak of tuberculosis among chronically homeless people in downtown Seattle 

has strengthened the ties among the Tuberculosis Clinic, HCH Network, and the major homeless 

shelters, day centers, and housing programs serving this population. For example, the network 

has set up a system by which individuals are housed in motels until they are no longer contagious 

and then DESC and PHG have set aside seven units that these clients can use. 

Affordable Housing 

Seattle is taking a number of measures to develop affordable housing plus a continuum of 

housing for homeless individuals. The City of Seattle Consolidated Housing and Community 

Development Plan serves as the application for four HUD programs-CDBG, HOME, ESG, and 

HOPWA.43 Its purpose is to identify needs related to housing, cost burdens, housing conditions, 

special populations, homelessness, and health and human development, and to describe the city's 

priorities to address these issues through specific activities funded by these Federal sources and 

other local funds. 

43 City of Seattle website - www.ci.seattle.wa.us 

G.23 
Appendix G: Seattle 

In addition, Seattle has a long history of voter-approved tax measures for low income housing 

and housing for1:10meless people. Voters approved housing levies in 1981, 1986, 1995, and 

2002. The 2002 housing levy totals $86 million over seven years with the cost to the average 

homeowner of $49 per year. 

44 The program includes five.major initiatives plus administrative 

costs: rental preservation and production (provides housing to people with disabilities, elderly, 

homeless, and working families and resources for rehabilitation, new construction, or 

redevelopment of units); home ownership for low-income working families; neighborhood 

housing opportunity program with a mixed income, mixed use emphasis; rental assistance to 

prevent homelessness; and operating and maintenance (for rental units for extremely low-income 

individuals and people with disabilities). 

Resources in Seattle that supportive housing developers may be able to use include: 

• 	 The Seattle housing levy with $6 million per year for 7 years devoted to housing 

affordable to households at 30 percent of median income housing - including capital and 

operating subsidy prioritizing those needing supportive services. 

• 	 The Sound Families Initiative (funded by the Gates Foundation) for $40 million over five 

years to provide PSH to homeless families, some of whom may be chronically homeless 

families. 

• 	 A combination of other Federal, state, and local funding sources such as HOPWA, 

CDBG, City of Seattle General Fund, Document Recording Fee Funds, ARCH, the 

Department of Corrections' "Going Home" program, Housing Innovations for Persons 

with Developmental Disabilities, Mental Health Housing Funds, and others. 

There is now a conscious strategy to have nonprofit agencies provide supportive housing with a 

back door to public housing and Section 8 subsidized private and non-profit housing. The 

approach to housing development in Seattle seems to be successful through public/private 

partnerships. Nonprofit agencies are capable of using the capital and operating funds available 

to develop housing and to create supportive programs that assist the populations of interest. 

However, funding for services remains more ad hoc than funding for capital and operating 

budgets. Service funds require separate applications and annual renewals. State and local budget 

cuts have created a relatively unstable funding environment. Funders are beginning to 

collaborate formally around these issues with city and county agencies expressing interest in 

creating a Housing Funders Group to formalize the approach. 

The seven public housing authorities in the Seattle region have organized to create project-based 

Section 8 vouchers. Project-based Section 8 provides operations and some service funds through 

enhanced allowance for property management. For example, $500 per month per unit goes to 

owners (with the resident paying some). If the property management and maintenance costs are 

$300 then there is some flexibility to use the rest ofthe money for operations such as enhanced 

44 Seattle Office of Housing website - www.cityofseattle.netlhousing 

G.24 
Appendix G: Seattle 

property management and services and it frees up Shelter Plus Care resource for others who need 

them. 

Seattle Housing Authority and King County Housing Authority have also set up a syst-em 

whereby people in Shelter Plus Care peITIlanent supportive housing can stay on the waiting list 

for Section 8 vouchers and access this program when they are no longer in need of the level of 

services Shelter Plus Care requires. Although the person is considered pennanently housed when 

in Shelter Plus Care, the housing authorities understand moving to Section 8 housing is yet 

another step on the continuum of care for homeless individuals, and it frees up Shelter Plus Care 

resources for others who need them. 

The YWCA also provides low-income housing units in downtown Seattle. Approximately 10 

percent of the women in its housing experienced chronic street homelessness and the vast 

majority would be homeless if they did not have this setting. No clinical services are provided in 

the permanent housing units. 

Documenting Reductions to Chronic Street Homelessness 

The SeattlelKing County Coalition for the Homeless oversees an annual one night street count 

and survey of homeless shelters and transitional programs that have been conducted for 24 years 

(SeattlelKing County Coalition for the Homeless, 2003). The survey of shelters and transitional 

programs is conducted the same night as the street count and produces unduplicated numbers of 

people using homeless services at the time of the count. The coalition returns annually to the 

same areas of the city and county to count street homeless individuals and also adds new 

neighborhoods to the count periodically. When comparing numbers of street homeless year after 

year, however, the coalition does some analyses that use a constant geographic area to avoid 

increases in numbers being attributable to the increase in area. From 1999 to 2002 the One Night 

Count of street homeless individuals went up 81 percent in "traditional count areas" from 983 to 

1,779. From 2001 to 2002 the total count of street homeless individuals went up 40 percent from 

1,454 to 2,040, but a substantial portion of that was from adding three new areas to the count. 

From 2001 to 2002, restricting the analysis to the 2001 geographic area, the number of street 

homeless individuals increased 23 percent in one year. From 1998 to 1999, during better 

economic times, a same geographic area count of street homeless individuals still went up 16 

percent in one year. 

During the 1999 to 2002 period, these increases in street homelessness occurred despite a 21 

percent increase (from 4,917 to 5,940) in the survey count of the number of homeless individuals 

in shelter or transitional shelters. The community is losing ground while making improvements 

in resources for homeless individuals. One explanation is that homeless individuals are drawn to 

or sent to Seattle from surrounding communities. Our focus group of homeless individuals 

indicated that Seattle was known to be a relatively "good" place to be homeless. In the October 

2002 One Night Count survey of shelters and transitional housing, 46 percent of the respondents 

indicated that their last peITIlanent address was outside Seattle. In the late 1990s there were 

skyrocketing housing prices in Seattle and some tearing down of single room occupancy 

buildings, and these economic pressures probably pushed more people on to the streets because 

they could not afford the available housing. More recently the job market has soured, and our 

G.25 
Appendix G: Seattle 

interviewees reported that rising unemployment is also creating economic factors that result in 

more people being on the street. Even if people laid off do not become homeless, some may 

move to low reni quarters, making the affordable housing market tighter. Finally, substance 

abuse treatment has been cut back. 

Of those using services in Seattle in 2002, 60 percent were single adults in shelter or transitional 

housing. Less than 1 percent used a safe haven. Forty-one percent of the homeless people using 

services were female and 38 percent were white (compared to 80 percent of the general 

population), 37 percent were African American (compared to 5 percent of the general 

population), 10 percent were Hispanic (compared to 3 percent of the general population), 5 

percent were Native American (compared to 1 percent of the general population), and 4 percent 

were AsianlPacific Islander (compared to 10 percent of the general population). The most 

frequently cited disabilities among homeless people using services were mental illness and 

chemical dependency. 

The increase in Seattle's homeless population in general and street homeless population in 

particular can be attributed to many challenges overwhelming the efforts of programs to tackle 

the issue of chronic street homelessness. Seattle has seen an economic downturn at the same time 

affordable housing has decreased. Indeed, individual program data from DESC, CPC, and AHA 

indicate these programs are successful in assisting chronically street homeless individuals into 

permanent supportive housing. 

Data in April 2003 from the Lyon Building, the Morrison Building,45 and Union Building show 

that of the residents ever served between 70 and 78 percent have been in the housing for at least 

12 months and between 39 and 58 percent have been in the housing for at least 24 months. 

Looking at the data from April 2002 without residents who enrolled in the building during the 

past year, 92 percent of clients remained in the Lyon Building for at least 12 months and 68 

percent stayed at least 24 months. For the Union Building, 75 percent remained at least 12 

months and 54 percent remained for 24 months. As further evidence of housing stability, looking 

at data from April 2001 without residents who enrolled in the building during the past two years, 

75 percent of residents in the Lyon Building remained for at least 24 months and 58 percent of 

residents in the Union Building did the same. 

An independent evaluation of the Lyon Building found that over 90 percent of the residents had 

been homeless at some time and 46 percent had been homeless for one-fourth of their adult lives 

(Northwest Resource Associates, 2002). Despite the high past incidence of homelessness among 

the Lyon Building's residents, 65 percent of them had lived there for more than three years 

(Northwest Resource Associates, 2002). 

The AHA's Wintonia and Westlake programs also appear successful at keeping clients in 

housing. The average length of stay at the Win toni a is 3 years. If residents stay for 2 to 3 years 

they likely move on to more independent living situations (such as the AHA's Josephinum 

house). If they leave before the 2-year mark they are likely having difficulty remaining in 

45 In October 2001, DESC acquired the Monison Building, formerly operated by the Seattle Housing Authority. 

G.26 
Appendix G: Seattle 

housing. The average length of stay at the Westlake is 5.5 years. Some residents transition to 

independent living and others transition into nursing care because of their age. 

In four years, the CPC's Harbor House, a 20-bed save haven program for people with severe 

mental illness, moved 151 formerly chronically homeless individuals (50 percent of clients ever 

served) to permanent supportive housing. 

Data from AHA's Wintonia and Westlake programs and DESC's Lyon and Union Buildings 

document that a substantial proportion of clients remain in housing for years. Although actual 

data about length of time on the street has not been gathered for these programs with the 

exception of the clients in the Lyon Building, both of these agencies are confident that they serve 

a chronically homeless group of people who have spent many years on the street outside of 

housing or service programs. 

The Crisis Triage Unit analyzed the effects of the case review process for 32 people, comparing 

their circumstances six months before the case review and six months after it. Results showed a 

62 percent reduction in using the unit's services during the six months after the case review 

compared to the six months before. A year later the same people still used the unit 60 percent 

less than before intervention. 

Of the 120 clients the REACH Project served in 2002,65 percent had improved or maintained 

their housing in either transitional or permanent supportive housing settings. Sixty-six percent 

had obtained substance abuse treatment. Seventy-three percent obtained income support and 53 

percent secured a protective payee. Eighty percent of the clients obtained non-urgent health care. 

In addition, in the past three years 60 REACH clients maintained housing for longer than one 

year and more than 25 percent of these maintained their housing for over three years. 

REACH staff members report that if homeless clients did not have intensive case managers 

working with them they likely would not sustain efforts to get housing or follow through on 

other issues such as medical concerns. 

Public Funding 

Funding sources for Seattle's many programs for homeless individuals are very diverse, and 

usually we cannot identify funding specifically for reducing chronic street homelessness. The 

following is an overview extracted from the SeattlelKing County Continuum of Care Proposal: 

• 	 In the 2002 fiscal year, the city committed $10.0 million and the County $3.2 million out 

of their general funds to combat homelessness, and they also provided staffing 

commitments representing 18 Full Time Equivalents. 

• 	 The Seattle Housing Levy is another important source of local government funding-in 

September 2002 Seattle voters renewed the housing levy, costing homeowners an average 

of $49 per year, that will generate $86 million over the next 7 years to provide low 

income and subsidized housing. 

G.27 
Appendix G: Seattle 

• 	 King County uses CDBG funding to acquire and rehabilitate rental units for homeless 

persons. Seattle uses CDBG funding to support the operations of emergency shelter, 

transitional housings, and daylhygiene centers. 

• 	 Seattle and King County Public Housing Authorities assign Housing Choice Vouchers to 

homeless households, and both have designated public housing units for homeless 

households. 

• 	 Seattle uses Mental Health Block Grant funds to administer involuntary treatment; the 

clients have included an unknown number of homeless individuals. In 2003 the funds 

will be used to fund HOST and the Crisis Triage Center. 

• 	 King County uses Substance Abuse Block Grant funds to support county services, 

including the Emergency Services Patrol, to homeless individuals. 

• 	 King County has a Regional Social Services Block Grant that supports services, primarily 

for DCFS staffIng, for an unknown number of homeless individuals. 

• 	 King County uses T ANF funds to assist homeless families and individuals. 

• 	 State programs, including the Washington State Housing Trust Fund and the Washington 

State Housing Finance Commission (tax credits for construction transitional housing), 

provide funding support for emergency shelter, transitional housing, acquisition, rehab 

and construction. 

• 	 Private and foundation funding supports programs providing food, emergency shelter, 

transitional housing, outreach and case management. 

• 	 Agencies use Federal funding from PATH and HCH to provide outreach and services. 

Seattle and King County also dedicate funds to HCH services. 

Community Relations and Advocacy 

Housing programs in Seattle sometimes face resistance from community members during 

development. Some believe the presence of housing for homeless and/or disabled individuals has 

many impacts on the community, some of which are adverse. Interviewees reported that 

responsible service providers should listen to the concerns of these neighbors and, to the extent 

possible, address them. At the same time however, the service providers should not change their 

approaches so dramatically that they can no longer achieve the agency's mission. 

G.28 
Appendix G: Seattle 

Currently Seattle is embroiled in a community relations battle over development ofDESC's 

1811 project-a housing program for chronic alcoholics. The program is intended to be a 

consumer choice housing facility using a housing first and harm reduction model. The 

Downtown Seattle Association, an influential business association, strongly supports the 1811 

project. Nevertheless, a wealthy business and a commercial development corporation in the area 

are opposing it. The corporation filed an appeal once DESC's master use permit was approved. 

The local decision ruled in favor of DESC and the corporation appealed to the county superior 

court. Again the decision ruled in favor of DESC. Currently the corporation plans to appeal to 

the State level. 

G.29 
Appendix G: Seattle 

In the meantime, DESC has spent $90,000 on legal fees during the appeal process and has been 

forced to return its tax credit to the State because of the time lost on the proJect. DESC will have 

to reapply for funding, extending development by two years. DESC has experienced resistance to 

other projects in the past, but not to this extent and each time it effectively won community's 

support. 

Often in Seattle the projects that begin with this type of opposition eventually become well liked 

in the neighborhood. For example, when AIDS Housing of Washington developed its BaileyBoushay House, a housing program designed for people living with AIDS, it faced extreme 

resistance from the community. Now, however, both the program and the building are an 

important and well-respected part of the community, which gives $1 million annually in private 

money to the program. 

In a similar vein, AHA experienced a high degree of community resistance when it established 

the Wintonia building, but now Wintonia is so integrated into the area that it hosts the 

neighborhood council meetings. The local school objected when the Wintonia fIrst opened, but 

now students from the same school put on shows every year for the Wintonia residents. 

Community residents see a positive impact on the street as public inebriation has declined with 

the Wintonia's presence. The people struggling with alcohol issues are drinking in a controlled 

environment. As part of the media coverage on the DESC 1811 project, the Seattle Times 

published a feature article on the Wintonia entitled "Wintonia Has Proved a Good Neighbor" 

(November 25,2002). Local residents and retailers from the Wintonia neighborhood have 

testifIed on behalf of the 1811 project. 

A number of agencies in Seattle have faced community resistance and many employ similar 

tactics to improve their relations with their neighbors. Some practical and successful strategies 

reported by service providers include: 

• 	 To the extent possible, agencies should seek sites that cannot be legally challenged and 

are not vulnerable to reversals of permits. 

• 	 Agencies should go into the development process knowing they must inform the 


community of their intentions. 


• 	 Agencies should act throughout the process with the attitude that people will ultimately 

do what is right. 

• 	 Agencies should include community members as early in the process as possible. The 

community should be notifIed of the project early on and should be updated often about 

its progress. 

• 	 Agencies should leaflet and/or make personal contact with the immediate neighbors in 

the area. 

• 	 Agency representatives should attend neighborhood/community boards or councils to 

explain the program as soon as they have site control. When convening these meetings, 

identify and mobilize your supporters within that community to attend the meeting. In 

0.30 
Appendix G: Seattle 

addition, ask supporters from other neighborhoods where similar housing has been 

accepted to come speak on behalf of the agency or the residents of such housing 

programs. 

• 	 A staff person should serve on the neighborhood/community board or council as long as 

the housing is open. 

• 	 Agencies should have open meetings with community members so concerns can be 

expressed and then addressed by staff. 

• 	 Agencies should not hide infonnation from the public about the nature of the population 

intended for the housing or the services that will be provided. 

• 	 Agencies should create opportunities for community members to get involved through 

clothing drives, fix-up days and other activities that engage neighbors and help improve 

their understanding of the residents. They also become sympathetic and supportive of the 

program. 

• 	 Once in the community, program participants should maintain the grounds, participate in 

cleanups, report suspicious activity and generally be good neighbors. 

Agencies in Seattle have often found that those most staunchly opposed to a program in the 

beginning are the same people who become the most supportive. Once they support the program, 

they can become references when it comes time to develop another housing program. 

The Future-Maintaining and Enhancing the System 

As noted above DESC is currently trying to move their 1811 project through litigation. This 

project will set up pennanent supportive consumer choice housing for chronic public inebriates 

and individuals with mUltiple barriers. 

CPC is working with King County Mental Health, Chemical Abuse and Dependency Division to 

create a plan for developing a significant new housing stock for persons with mental illness. CPC 

has two new construction projects currently underway. One project, a partnership with the 

University of Washington, will provide transitional housing to homeless, mentally ill, and 

chemically dependent pregnant and postpartum women and their children in order to research the 

impact of fetal alcohol births. CPC is also working with East King County officials and 

advocates to develop new and needed housing opportunities for the east county's underserved 

homeless mentally ill population. A new cluster housing project is currently in development in 

the east county and a unique "accessory dwelling unit" pilot project is in the planning stages. 

Seattle and King County are developing an HJv1]S called Safe Harbors for their Coe. At this time 

they are completing their assessment of existing agency infonnation systems and delineating the 

specifications for the system. Some agencies are reluctant to support the HJv1]S because they fear 

it could be used to deny clients services because of infonnation about their past. 

G.3! 
Appendix G: Seattle 

The Committee to End Homelessness (CEH) is a new group with an emerging "senior role" for 

planning around ending homelessness in King County. The CEH meets monthly and has two 

representatives nominated by each of the eight founding organizations (City of Seattle, King 

County, King County Judicial Drug Court, United Way, Coalition for the Homeless, and the 

Human Service Organizations of North King County, South King County, and East King 

County). These organizations have also committed resources and senior staff members. The CEH 

is being expanded to 30 members by adding at-large members. Like the coalition, this group 

does not have a specific focus on chronic street homelessness. Chronic homelessness will be a 

priority area for the CEH to work on. 

G.32 
Appendix G: Seattle 

Seattle Site Visit Participants 

.. 
 -

Walt Adam 

Graydon Andrus 

Mary Burki 

Paul Carlson 

Donald Chamberlain 

Christina Clayton 

Don Clayton 

Nancy Cole 

Tara Connor 

Georgia Conti 

Kelley Craig 

Edward Dwyer-O'Connor 

Michael Elsner 

Trudi Fajans 

Sheila Fries 

Chloe Gale 

Bill Hallerman 

Shirley Havenga 

William Hobson 

Ron Jackson 

Ken Kraybill 

Betsy Lieberman 

- - - -

- -

Mental Health, Chemical Abuse, and Dependency Services Division, King County 

Department of Community and Human Services 

Downtown Emergency Service Center 

Housing and Community Development Program, Community Services Division, King 

County Department of Community and Human Services 

Sound Families Initiative, Homeless and Supportive Housing Specialist, Office of 

Housing, City of Seattle 

AIDS Housing of Washington 

Homeless, Outreach, Stabilization, and Transition Project, Downtown Emergency 

Service Center 

Homeless, Outreach, Stabilization, and Transition Project, Downtown Emergency 

Service Center 

Plymouth Housing Group 

Plymouth Housing Group 

Community Services Division, Human Services Department, City of Seattle 

Reach Project, Evergreen Treatment Services 

Harborview Medical Center 

Mental Health, Chemical Abuse, and Dependency Services Division, King County 

Department of Community and Human Services 

Health Care for the Homeless Network, Department of Public Health, Seattle and King 

County 

Shelter Plus Care Program, Plymouth Housing Group 

Reach Project, Evergreen Treatment Services 

Archdiocesan Housing Authority 

Community Psychiatric Clinic 

Downtown Emergency Service Center 

Evergreen Treatment Services 

National Health Care for the Homeless Council 

AIDS Housing of Washington 

G.33 
Richard Liranzo 

Daniel Malone 

Emily Meyer 

Mike Nielsen 

Glenette Olvera 

Alan Painter 

Wendy Pompey 

Diana Powers 

Ashley Proto 

Craig Rennebaum 

Jim Rhodes 

Lisa Cunningham Roberts 

Bill Rumpf 

Rita Ryder 

Sue Sherbrooke 

Marian Shugrue 

Kate Speltz 

Joe Thompson 

Patrick Vanzo 

Linda Weedman 

David Wertheimer 

Janna Wilson 

Appendix G: Seattle 

Plymouth Housing Group 

Downtown Emergency Service Center 

Homeless, Outreach, Stabilization, and Transition Project, Downtown Emergency 

Service Center 

Community Psychiatric Clinic 

Harborview Community Mental Health Center 

Community Services Division, Human Services Department, City of Seattle 

Dutch Shisler Sobering Center, Mental Health, Chemical Abuse, and Dependency 

Services Division, King County Department of Community and Human Services 

YWCA of Seattle-King County & Snohomish County 

Homeless, Outreach, Stabilization, and Transition Project, Downtown Emergency 

Service Center 

Mental Health Chaplincy 

Homeless, Outreach, Stabilization, and Transition Project, Downtown Emergency 

Service Center 

Health Care for the Homeless Network, Department of Public Health, Seattle and King 

County 

Office of Housing, City of Seattle 

YWCA of Seattle-King County & Snohomish County 

YWCA of Seattle-King County & Snohomish County 

The Westlake, Archdiocesan Housing Authority 

Housing and Community Development Program, Community Services Division, King 

County Department of Community and Human Services 

Archdiocesan Housing Authority 

Cross Systems Integration Efforts, King County Department of Community and Human 

Services 

YWCA of Seattle-King County & Snohomish County 

Kelly Point Partners 

Health Care for the Homeless Network, Department of Public Health, Seattle and King 

County 

G.34 
Appendix G: Seattle 

Seattle Acronyms 

ACCESS 	 Access to Community Care and Effective Services and Support 

ACH 	 Seattle-King County Advisory Conunittee on Homelessness 

AHA 	 Archdiocesan Housing Authority 

AHW 	 AlDS Housing of Washington 

CEH 	 Committee to End Homelessness 

CPAC 	 Chronic Populations Action Council 

CPC 	 Community Psychiatric Clinic 

DCFS 	 Department of Children and Family Services 

DESC 	 Downtown Emergency Service Center 

DSHS 	 Department of Social and Health Services 

FTE 	 Full Time Equivalent 

HCH 	 Health Care for the Homeless Network 

HMC 	 Harborview Medical Center 

HOST 	 Homeless, Outreach, Stabilization, and Transition (Outreach and case 

management project through the Downtown Emergency Service Center) 

LUll 	 Low Income Housing Institute 

MHCA 	 Mental Health, Chemical Abuse and Dependency Services Division 

PATH 	 Projects for Assistance in Transition from Homelessness 

PHG 	 Plymouth Housing Group 

REACH 	 Reaching out and Engaging to Achieve Consumer Health 

RWJ 	 Robert Wood Johnson 

SPNS 	 Special Projects of National Significance 

SHB 	 State House Bill 

0.35 
Appendix H, Glossary 

AACP 

ACCESS 

ACLU 

AHP 

AMI 

BLS 

CDBG 

CMHC 

CoC 

CPS 

DHHS 

DMH 

DOL 

ES 

ESG 

FEMA 

FHLBank 

FMR 

HAP 

HMIS 

HOME 

HOPE VI 

HOPWA 

HUD 

LIHTC 

Medi-Cal 

MHBG 

MSA 

NIDA 

NIMBY 

NLIHC 

NOFA 

PATH 

PSH 

RMU 

S+C 

SHIA 

SABG 

SAMHSA 

SHP 

SHU 

SJvfl 

SPA 

APPENDIX H: GLOBAL ACRONYMS 


American Association of Community Psychiatrists 

Access to Community Care and Effective Services and Support 

American Civil Liberties Union 

Affordable Housing Program 

Area Median Income 

Bureau of Labor Statistics 

Community Development Block Grant 

Community Mental Health Center 

Continuum of Care 

Current Population Survey 

Department of Health and Human Services 

Department of Mental Health 

Department of Labor 

Emergency Shelter 

Emergency Shelter Grant 

Federal Emergency Management Act 

Federal Home Loan Bank 

Fair Market Rate 

Housing Assistance Plan 

Homeless Management Information System 

Federal block grant to create affordable housing 

Homeownership and Opportunities for People Everywhere 

Housing Opportunities for Persons with AIDS 

Department of Housing and Urban Development 

Low Income Housing Tax Credit 

California's Medicaid program 

Mental Health Block Grants 

Metropolitan Statistical Area 

National Institute on Drug Abuse 

Not In My Backyard (meaning, don't put that program in my neighborhood) 

National Low Income Housing Coalition 

Notice of Funds Availability 

Projects for Assistance in Transition from Homelessness 

Permanent Supportive Housing 

Rent, Mortgage and Utility payments 

Shelter Plus Care 

Supportive Housing Initiative Act 

Substance Abuse Block Grant 

Substance Abuse and Mental Health Services Administration 

Supportive Housing Program 

Supportive Housing Unit 

Seriously Mentally III 

Service Planning Areas 

H.l 
SRO 

SSDI 

SSI 

TANF 

VA 

WIA 

YMCA 

YWCA 

Appendix H, Glossary 

Single Room Occupancy 

Social Security Disability Income 

Supplemental Security Income 

Temporary Assistance for Needy Families 

U.S. Department of Veterans Affairs 

Workforce Investment Act 

Young Men's Christian Association 

Young Women's Christian Association 

H.2 
Appendix H, Glossary 

H.3 
APPENDIX I: METHODS 


The methods involved in this study were very simple, consisting of site selection and site visits. 

Site Selection 

We followed a two-stage process for identifying "exemplary" models or approaches to ending 

chronic street homelessness, during which we were looking for sites that: 

• 	 Had a plan, and had gone some distance toward implementing it, such that the relevant 

programs and services to reduce chronic street homelessness were functioning for at least 

one and preferably 2-3 years; 

• 	 Involved a systematic, coordinated effort of many programs, not just a single program; 

• 	 Had one or more ways to document the effectiveness of their approaches, ideally a time 

series of street counts. 

In addition, we were looking for a judicious blend of communities to represent variations on 

some important characteristics, such as: 

• 	 Whether the whole spectrum of chronically street homeless adults are assisted, or 

whether assistance focuses on particular subgroups (e.g., those with severe mental illness, 

or veterans); 

• 	 The degree to which mainstream agencies are involved, and which ones. Strategies 

involving mental health, substance abuse, corrections, and veterans affairs agencies might 

be quite different, and informative to observe; 

• 	 Clear organizational and administrative structures; and 

• 	 Ongoing funding streams. 

We also focused on fmding communities where the homeless population is mostly "homegrown," as the problem of ending street homelessness is far more difficult in locations that serve 

as magnets for homeless singles. 

To begin the process of fmding sites to visit, the Urban Institute (UI) emailed experts describing 

the study and requesting their advice on communities with exemplary practices. We received a 

tremendous response to the email request for information, and Walter R. McDonald & 

Associates, Inc. (WRMA) staff requested copies of relevant studies identified by the 

respondents. The senior project team members developed a discussion guide for calls to 

community/ program directors and/or Continuum of Care conveners to confmn that the 

recommended sites met our criteria. The guide is reproduced at the end of this appendix. We 

used the first three pages only for the first wave of screening calls, and the rest of the guide for 

the follow-up calls. 

I.l 
Appendix I: Methods 

Dr. Burt, from the Urban Institute, conducted a project team conference call training session on 

how to do the screening calls. Following the training, the project team gathered screening 

infonnation through calls to community/program directors. During this process, some additional 

programs were identified that looked promising. Following HUD review and reactions to the first 

wave of screening calls, we again contacted the siteslcommunities of most interest with more 

detailed follow-up calls using the last part of the screening protocol. 

In addition to programs that we identified as most promising, we also made follow-up calls to 

other programs or parts of systems in which those sites were embedded. To facilitate 

comparisons of community-wide systems, site infonnation obtained from calls, emails, and 

documents were organized into a community site report fonn so that all reports would be in the 

same fonnat. Each community site report included infonnation about the individual programs we 

contacted that are part of the community-wide system. In some cases, if the program was not part 

of the community-wide system, it was so large as to provide systemic housing and services to a 

particular population within the community. 

First Screening Round 

To arrive at the initial list of 25 sites, we began with over 120 programs, including: 

• 	 A list of approximately 70 safe haven programs from the Corporation for Supportive 

Housing; 

• 	 34 communities involved in California's Integrated Services for Homeless Adults with 

Serious Mental Illness program (known after the bill number by which it was introduced 

into the California Assembly, AB 2034, which began with three pilot sites and then was 

expanded by the legislature); 

• 	 Several programs recommended by the Corporation for Supportive Housing in 


California; 


• 	 Several Veterans Affairs Comprehensive Homeless Centers; 

• 	 7 downtown business partnerships; 

• 	 2 Ohio programs identified during the Continuum of Care Evaluation; 

• 	 9 sites already heavily evaluated for the Connecticut Supportive Housing Demonstration 

Program; 

• 	 The heavily evaluated Pathways programs in New York City and Westchester County; 

• 	 4 projects funded by the National Institute on Drug Abuse (NIDA); 

• 	 A project that transitioned from an Access to Community Care and Effective Services 

and Supports (ACCESS) project; and 

1.2 
Appendix I: Methods 

• 2 self-referred programs in Seattle. 

Clearly we had to winnow these 120 programs down to the most promising 25, which would be 

further narrowed after fInal screening calls to 10 to 15 programs. We did that winnowing in 

several ways. 

Safe Havens 

We received a list o£close to 70 safe haven programs from the Corporation for Supportive 

Housing. Safe havens, by their nature, help-street homeless people with disabilities take the first 

step off the street, which may be to a low barrier emergency shelter or-indefmite stay transitional 

housing program. The list we received did not indicate whether any were part of systematic 

efforts in their community to reduce chronic street homelessness, and specifIcally whether they 

were linked with programs that either did outreach to bring people into the safe haven or to 

permanent supportive housing (PSH) to help them leave homelessness. Nor did it indicate 

whether any of them could document their impact in reducing chronic street homelessness. 

Because we needed to narrow the list considerably, we contacted Vanessa Bernard of the Office 

of Special Needs Assistance Programs (SNAPS) within HUD's Community Planning and 

Development Division, and Ann O'Hara of the Technical Assistance Collaborative, Inc. in 

Boston to ask which ones we should pursue. Vanessa Bernard identified three-Pathfmders in 

Lowell, Massachusetts, Project H.O.M.E. in Philadelphia, and Harbor House in Seattle. Project 

H.O.M.E. is included in our list of25, as is Harbor House in Seattle. We called the Lowell 

program and found that it is small and not linked in a systematic way to other programs, so we 

did not include it in the initial list of 25 communities/programs recommended for site visits. 

Ann O'Hara identified two programs for further exploration-Hawaii and Atlanta. We 

interviewed both. The Hawaii program was identifIed as a HUD model for the nation in 1997. 

However, it lost much of its support from mainstream agencies, and it is questionable whether it 

is a model any more, so we dropped it from our list of promising sites. We could not ascertain 

whether the Atlanta program had suffIcient data on the proportion of the people served who were 

chronically street homeless and how many became stably housed and experienced other impacts. 

While that safe haven program has become integrated into a larger effort and the model appears 

likely to be having an impact were the program able to document impact, because our original 

list of 25 had so many other promising sites, HUD did not select Atlanta for a second round of 

screening calls. 

Veterans Affairs Homeless Programs 

The Department of Veterans Affairs (VA) has fIve Comprehensive Homeless Centers (in Dallas, 

Little Rock, Cleveland, Los Angeles, and New York City) and a host of other programs serving 

homeless veterans in many places. All have good data on reductions in homelessness thanks to 

the evaluation system maintained by Dr. Robert Rosenheck at the VA's Northeast Program 

Evaluation Center. Dr. Rosenheck's data indicate that on average about 20 percent of people 

seen at VA homeless programs have current spells of homelessness of 12 months or more. But 

the VA does not have data on lifetime homelessness, or number of episodes. The odds are that 

I.3 
Appendix I: Methods 

somewhere between 35 and 50 percent have had previous episodes that would qualify them as 

chronic. 

To narrow the field, we asked Dr. Rosenbeck which of the comprehensive centers he thought 

were best/most exemplary, and also whether there were other VA programs that we should 

consider as best practices. He identified two of the comprehensive centers: Los Angeles because 

it is massive, multi-faceted, and has strong links with local providers; and Dallas because, while 

it does not have a significant housing component connected to it, does concentrate on 

employment and seems to have some success with getting people jobs. So we called those two. 

In addition, we checked out the VA program in New HavenlWest Haven, because Dr. Rosenheck 

said it was very good and had strong linkages to housing. It is also in the same place as some of 

the Connecticut Supportive Housing program's local sites, and we wanted to see the connections 

among them. All three were included in the list of 25, but other V A sites were never called. 

BID-Sponsored Programs 

We obtained a copy ofAddressing Homelessness: Successfol Downtown Partnerships, a study of 

programs sponsored by Business Improvement Districts (BIDs) that address homelessness, 

published by the International Downtown Association (2000). It covered BID projects in 18 

cities. We could tell just from the report that many would not be relevant to this study, but we 

did check out BID projects in Philadelphia; San Diego; Washington, DC; and Times Square, 

New York City. The BID project in Philadelphia is part of the community system that we studied 

during the site visit to that city. While the Times Square BID continues to support the 

Consortium on the Homeless that it helped establish, it no longer provides any funding and the 

Consortium appears to be quite independent of the BID. The Consortium runs a very small 

respite center that has beds for seven men (and one emergency cot) and appears to have little 

systematic impact information. The Washington, DC project has many good aspects but 

connection to housing is not one of them. Hence those two were not on the list of the initial 25 

sites that we recommended. The San Diego business partnership is not actually a BID, but is 

involved in San Diego's comprehensive effort that is on the list. It is interesting in its own right 

as an example of significant business involvement in homeless issues. 

NIDA Demonstration Programs 

We received information about several demonstration programs for substance-abusing homeless 

people, funded by NIDA. Most of these programs focused on reducing substance abuse, but not 

necessarily on ending homelessness. They did not have a strong connection to housing, and had 

very high treatment dropout rates (around 80 percent), so we did not pursue them. One, the 

Birmingham, Alabama project, did appear to have that connection, and it turned out to be true. 

So we included it in the initial list of 25 recommended sites. We also were able to contact a 

NIDA project in New York City, but it was very limited in scope and had no impact data. 

1.4 
Appendix I: Methods 

California's Integrated Services for Homeless Adults with Serious Mental Illness 

Califorrua's Department of Mental Health (DMH) funds counties under Assembly Bill 2034 (and 

before that, Assembly Bill 34) to provicle integrated services to homeless people with mental 

illness, including the services needed to leave homelessness. The program as a whole has a 

strong evaluation system, which shows considerable reduction in homelessness for the people in 

the program. The program only reaches about I opercent of potentially eligible individuals, due 

tD a lack of resources to serve the others. Three pilot counties were funded in the program's frrst 

year (1999); there now are (or are about to be) programs in 34 of the state's 54 counties. We 

checked out seven sites that the state program administrator said were the strongest, including 

the three pilot sites. Four of these were included in the list of25 recommendations. Three that we 

contacted (Madera, Humboldt, and Fresno) were judged to be too small to add to the list, given 

that we had other examples of these AB 2034 programs in cities where we could also check out 

other connected programs and strategies. 

New York City Programs 

In addition to Pathways, which was included on the initial list of25 potential sites, we contacted 

Housing Works and the Times Square BID/Consortium on the Homeless. The latter appears to 

have fallen apart, or at least its links to housing are no longer strong. Housing Works (a program 

focusing on people with HIV/AIDS, many of whom are or were homeless) has no data. So 

neither program made the initial list of25. 

Other Programs 

We interviewed two other programs to which people had referred us: an outreach program in 

New Haven, Connecticut that had been an ACCESS program; and Mercy Housing in San 

Francisco. Neither was judged appropriate for this project. In addition, HOD asked us about 

specifrc cities, which we checked out and found that: 

• 	 Memphis has good standards, a good data system (both street counts and unduplicated 

residential program data), but does not have a systematic service structure to reduce 

chronic street homelessness. It also has signifrcantly less than optimal mainstream 

involvement, especially for housing resources. Based on the Continuum of Care (CoC) 

site visit, it also has hardly any PSH beds. 

• 	 St. Louis has a data system that is basically a system of intake and referral-to-the-nearestempty-bed. It does not have a systematic approach to reducing any type of homelessness. 

It does have a longitudinal research project that has followed hundreds of homeless 

people for several years according to David Pollio, the researcher on the longitudinal 

project. 

• 	 Kansas City has the same sort of data system (intake and referral) as St. Louis. It does not 

have a systematic outreach-to-housing service structure or a systematic approach to 

ending street homelessness. 

1.5 
Appendix I: Methods 

• 	 An informant from Miami was among the people we contacted for recommendations 

about potential sites. She is, in fact, the Corporation for Supportive-Housing's main 

contact for Florida, and might be expected to know if Miami offered any opportunities 

for our study. She referred us to the assessment of the BID efferts to reduce 

homelessness, but did not say anything about Miami as a relevant site. We therefore did 

not pursue it. 

• 	 Chicago did not appear to have any programs reputed to meet our criteria. 

• 	 Portland was included in the initial list of 25. 

Second Round Screening 

Based on information obtained from emails, evaluation reports, telephone interviews, websites, 

studies identified by experts, and other documents, the project team identified sites that have 

promising practices, meet our criteria, and appear appropriate for more in-depth study through 

site visits. The follow-up interviews confirmed that the sites we identified as most promising in 

our [lIst deliverable would be appropriate for site visits. 

During the second screening round, we tried to capture the community-wide model or approach, 

including all the programs or agencies involved with chronic street homeless people from initial 

contact through permanent housing. We also tried to determine whether community-wide efforts 

provide the variety of programs necessary so homeless individuals may immediately access 

services and some type of housing even if individual programs have rules that would make it 

more difficult to engage homeless individuals. 

\Vhen inquiring about the target population, we again tried to determine whether the program or 

approach targeted chronic street homeless individuals, but we were still not always able to make 

this determination. Most programs and systemwide efforts told us they were targeting homeless 

individuals or homeless individuals with specific types of problems. While it was clear that some 

individuals with these problems had been on the street for long periods, few programs could 

document the proportion who were chronic street homeless individuals. After talking to more 

people within each community for the second screening round, we were able to determine that 

most communities we were considering could document levels of street homelessness through (at 

least) annual street counts. 

We had similar continuing difficulties with identifying the scale/scope of the program or 

community effort. Some people with whom we spoke about community-wide efforts were 

unable to teU-us the size of the community's homeless population and certainly not the size of 

the chronically homeless or street populations. Almost all programs/community efforts were able 

to identify the agencies with which they work. 

The extent to which programs could document their impact on the chronic street homeless 

population was difficult to assess in the first round of screening and continued to be a problem in 

the second round. Programs that could not provide any documentation in response to our first 

screening round were not included in the 25 programs that emerged from that round. In the 

second round of screening, we attempted to identify not only individual program data that might 

1.6 
Appendix I: Methods 

be available, but also whether the community conducted street counts, participated in an HMlS, 

or had some_other type of community-wide data. 

Based on second round screening, the project team verified the preliminary assessment of sites 

from the first round. We determined that some cities had several program sites that were fairly 

well coordinated as citywide efforts, and recommended that we combine these sites and spend 

more time in those communities. We could thus visit more programs than initially anticipated 

(but fewer cities) and focus on understanding the ways in which they are coordinated, how 

government and private sector agencies participate, and what evidence they have that the number 

of street homelessness have been reduced. 

The communities of Boston, Columbus (OR), Los Angeles, Philadelphia, San Diego, and Seattle 

include 14 of the programs originally recommended for further study through a site visi t, in 

addition to other programs. In addition, Birmingham, the location of the NIDA research project, 

was found to have a community-wide system that brings people in from the street and provides a 

variety of programs and types of housing until they achieve stable housing. Thus Birmingham 

also has several programs that would be worth visiting. 

Site Visits 

We visited seven cities, spending four days in Philadelphia, Los Angeles, and Seattle; three days 

in San Diego; and two days in Columbus, Boston, and Birmingham. During site visits we 

interviewed representatives of each community's overall planning and program development 

process, and representatives of selected programs that were part of the service structure 

addressing chronic street homelessness. We also held at least one focus group per city with 5 to 

10 homeless and formerly homeless program clients who had been chronically homeless on the 

streets. Appendix C of this report gives the names and affiliations of everyone interviewed, with 

the exception of those who participated in focus groups. The master discussion guide for 

interviews with program and agency representatives and the focus group guide are attached to 

this appendix following the screening discussion guide. 

1.7 
Appendix I: Methods 

46 DISCUSSION GUIDE FOR USE WITH-CANDIDATE SITES

HUD REDUCING CHRONIC STREET HOMELESSNESS PROJECT 

-Community (City/State): 


Name of Program/Collaboration/Agency: 


NamelTitle/Contact Information of Person Interviewed: 


Role of Person Interviewed (convener, data person, program director, etc.): 


Interview Date: 


Interviewer: 


Introduction 


If calling back to someone you've already interviewed: 


This is , again, with (WRMA or UI). I (or if it wasn't you) spoke to 

you a while ago about your program/initiative to reduce chronic street homelessness. We're 

calling back because we're potentially interested in coming to to learn more 

about how your community is doing this. 

If calling someone for the ftrst time: 

Hello, my name is ,and I am with (WRMA or UI). I am working on a project 

for HUD to learn about successful approaches to reducing or ending chronic street homelessness. 

I have already spoken with , who said that you/your agency is actively 

involved in this effort in (name of community). Is that correct? Are you 

the person I should be talking to, or is there someone else? 

Get to the right person, andfind out what the connections are between this agency 

and the ones we know about. Ifthe connection is not there and the original people 

said it was, try to find out what's going on. 

46 We have condensed this discussion guide by eliminating the spaces left for writing respondent answers, in the 

interest of report brevity. 

1.8 
Appendix I: Methods 

Overview of Community/Understanding of System 

Definitelv ask these questions for San Diego (downtown area), Philadelphia, Boston 

(Area A), Seattle, and Columbus. Try it also for Birmingham. 

We're trying to understand the extent to which your community has a coordinated system 

designed to find street homeless people, bring them into services, and eventually help them move 

out of homeless ness permanently. We understand that something like this exists in _____ 

Is that true? If yes, how long has it been operating? 

Ifjust a plan, when do you expect it wili begin to operate? 

Could you describe it to me, and where your program/agency fits into the system? Get overall 

description - what agencies and programs are involved, what are their roles? Get full contact 

information for each. 

Who developed this system? Who is the best person to describe it to us? Get full contact 

information. 

Who runs/orchestrates/coordinates this system? Get full contact information. What exactly do 

they do as part of that coordination? 

Iftalking with someone with an overview for the whole community: Over the course of this 

system's existence in its current form, about how many chronically homeless single adults have 

been helped to leave homelessness permanently in ? 

How do you know they have left permanently? What data do you have to show that? 

Use the next section ifyou are talking to someone who actually nms a service program. It is not appropriate for a 

convener data etc. 

The next section asks about your own program and who you serve. Then we'll return to the issue 

of how your program gets its clients and how it connects to other programs and agencies in 

Characteristics and Numbers of Peop]e Served 

Does your program focus on any specific problems or sub-populations of chronically homeless 

street people-i.e., does a person have to have the condition/problem to be eligible for the 

program (probes: alcohol, drug or mental health problems, HIVIAIDS, veterans, etc.)? 

In addition to any conditions/problems that are a criterion for eligibility to your program, what 

other problems affect significant proportions of the chronically homeless single adults you serve 

(whether or not your program/initiative focuses on these problems)- e.g., alcohol, drug, mental 

illness, HIV / AIDS, etc.? 

Other than the criteria of condition/problem you just described, do people have to meet specific 

criteria to participate in your program/initiative? What are they? 

1.9 
Appendix I: Methods 

About how many on-the-street chronically homeless single adults do you serve over a given 

month or year? About what share of all such people in your community is this? If your clients are 

not coming to you directly from the_street, how many had spent significant time on the streets 

before starting the chain of connections that led them to you? 

Over the course of your program/initiative's existence in its current fonn, about how many 

chronically homeless single adults have you helped to leave homelessness pennanently? 

How do you know they have left pennanently? Data? 

End ofquestions asked during the first screening round. Begin second round questions. 

How Your Program Works with Other Agencies or Programs 

As part of its work to end chronic homelessness, does your program/initiative coordinate with 

other agencies or programs? 

Ifwe know oVare planning to go to other programs in the community, list them here and ask 

about them first (I'm supplying 4 chances to insert programs we know about. If that's not 

enough, add more): 

Do you work with ___________ (repeat for all types of agencies)? 

In what ways? 

Other programs/agencies you work with: 

Which government agencies do you work with to help reduce chronic street 

homelessness? 

Public housing authority? No Y es ------~ Does that agency: 

__ Bring chronically homeless people into the system initially 

__ Move people through or within homeless-specific programs and services 

__ Move people out of homelessness 

__ Pay for housing/paying for supportive services 

__ Develop/manage housing 

__ Provide supportive services 

__ Develop and maintain public support 

Other 

For every activity checked, please describe the role of this agency and your program's 

relation to it in some detail 

Same set of questions asked about the following agencies: mental health, substance 

abuse, Veterans Affairs, community development, welfare, child welfare/foster care, 

corrections/police agencies. 

What nongovernmental agencies/programs do you coordinate with and how does each 

of these contribute to ending chronic street homelessness? 

1.10 
Appendix I: Methods 

What agencies or programs are involved in bringing chronicaUy homeless people into 


the system initially? How do they work? How do they connect to your program? 


What agencies are involved in moving people through or with-in homeless-specific 


programs and services? How do they work? How do they connect to your program? 


What agencies or programs are involved in moving people out of homelessness? How 


do they work? How do they connect to your program? 


What agencies or programs are involved in paying for housing/paying for supportive 


services? How do they work? How do they connect to your program? 


What agencies or programs are involved in developing/managing housing? How do 


they work? How do they connect to your program? 


What agencies or programs are involved in providing supportive services? How do they 


work? How do they connect to your program? 


What agencies or programs are involved in developing and maintaining public 


support? How do they work? How do they connect to your program? 


What agencies or programs are involved in developing and maintaining data to 


document services delivered and accomplishments of the system? How do they work? 


How do they connect to your program? 


Note to us: we may be able to combine the government and other program sections, just asking the questions for the 

other programs, and then determining whether they are governmental, homeless-specific, or other nonprofit. 

Are there any additional sources of financial or in-kind support (including private sector or 

philanthropic) or interagency cooperation that make your program/initiative work? What are they 

and why are they essential? 

Measuring Impact 

Are there any data or other ways of measuring the impact of this program/initiative on chronic 

street homelessness? E.g., fewer homeless people visible on the streets, fewer days homeless 

during a specified period than before program involvement. 

Ifyes, get details ... what kinds ofdata/measures, how collected, when (one-time or ongoing), 

and by whom. Also, ifwe don't already have them, get copies ofdata collection forms, sample 

data sheets, summaries ofmost recent data, evaluation reports, etc. Ask specifically about 

measures that can show reductions in chronic homelessness. 

Has your community conducted counts (or developed estimates) of its chronic street homeless 

population? (ifyes, get the data. Also get details ... who, how, where, when, etc., contact person 

for additional information.) Do these counts document changes (reductions) in the numbers of 

chronic (or street) homeless? 

Do you think your program/initiative could be easily replicated in other communities interested 

in reducing chronic street homelessness? Why (or why not)? Have there been any issues highly 

unique to your community that might affect another community's ability to replicate this 

program/initiative (probes: historical, political, demographic, or fiscal issues). 

Thank you for speaking to me about this program/initiative. We will probably be speaking with 

you again, as it is likely that we will be coming to for this project. Please 

feel free to call us with any follow-up questions or to provide us with any additional information. 

1.11 
Appendix I: Methods 

Interviewer: Please be sure to give them our e-mail address, phone number, and mailing address, 

and remind them to send us any materials that might helpful (e.g., evaluation fmdings, 

community action plans, etc.) 

NOTE ·HERE - all materials they have promised to send (and come back and check off when 

you get them) 

I.12 
Appendix 1: Methods 

History/Overview/Context Discussion Guide 

1. 	 Describe the community's approach for ending/preventing chronic street homelessness. 

1.1. What are the homeless-specific components? 


1.1.1. Street outreach/drop-in 


1.1.2. ES 


1.1.3. TH 


1.1.4. PSHISHELTER PLUS CARE 


1.1.5. Other housing 


1.1.6. Other agencies involved (e.g., emp1 and training, HCH)? 


1.2 What mainstream agencies are involved? 


1.2.1 What is the role of each? 


1.2.2 How does each fit in with each of the others? 


1.3 	 Be sure you have a Who Does What (Exhibit 1) chart that several people have 


reviewed, corrected, and approved. 


1.4 Can you draw a pathway or several pathways that show these interconnections, as a 


chronic street homeless person would experience them? How many common, regular 


ways are there for a chronic street homeless person to get from the streets into stable 


housing, with or without supports? 


2. 	 Who/what coordinates and administers the system? Whose responsibility is it to assure 

that all the pieces are working together? 

2.1. How does this happen (e.g., weekly meetings of key staf£'providers, case tracking or 


other data feedback on a regular basis)? 


2.2. How does the actual coordination work? 


2.3 . How many levels of coordination are there? E.g., 


2.3.1. Agency heads for policy decisions, 


2.3.2. Mid-level managers for agency-to-agency bottlenecks 


2.3 .3. Caseworkers for integrated case management 


3. 	 So far, what has it cost to develop and coordinate the system (not including costs for the 

actual homeless-related programs)? 

4. 	 What needs of which chronic street homeless people does the system address? 

4.1. Are there special focuses or specialization? (e.g., for SMl, substance abusers, PW As, 


veterans) 


4.2. Do some subgroups get more attention/resources than others? 


I.l3 
Appendix I: Methods 

5. 	 If the system is also structured to prevent people with histories of chronic street 

homelessness from becoming homeless again: 

5.1. How does it do this? 

5.2. For all chronic street homeless, or, if for particular subgroups, which ones? 

5.3. How are these people "credited" to the system since they may not .actually become 

homeless again? 

6. 	 If you feel your system uses a particular· model of models of care (e.g., housing first, stages 

in a continuum, clean and sober vs. not, voluntary vs. mandatory service participation), could 

you describe it/them and why you have chosen these approaches? 

7. 	 History. Nothing springs full-blown; it is important for us to understand how your approach 

has developed to date, and what you are planning for the future. 

7.1 What were the stages/phases/steps you went through to get to the system you have 

today? 

7.2 What were the success points, turning points? 

7.2.1 	 How was the cooperation/active participation of critical components achieved? 

7.2.2 	 Were there critical incidents or events or plans that changed your approach (e.g., 

new stadium, new loitering ordinance, desire to develop riverfront)? 

7.2.3 	 What were the issues/tensions, and what pushed things forward? What were the 

obstacles and how were they handled? 

7.3 How long has it taken so far? 

7.4 Assuming that you are not finished, what are the next stages you hope to accomplish? 

What are the gaps or problems with the current system, and what are you planning as 

ways to fill them? 

8. 	 Who made it happen? Describe the leadership, to begin with., along the way, and now. Is 

anyone so critical that if s/he left, the system would be in jeopardy? 

9. 	 How were/are community relations handled? 

9.1. What were the attitudes and roles of the police, business owners, transit authorities, 

others with a particular interest/problem with street homeless? Were these negative or 

positive? 

9.2. Did they change, and if yes, how and to what? 

9.3. How do you avoid the NIMBY response? 

10. Did you have providers who were willing and able to take on chronic street homeless 

people, with all of their problems? 

10.1 If yes, please describe. 

10.2 	If no, or not enough, what have you done to try to increase their willingness, or ability, 

or both? What have been the issues, what issues are still "hot," and how were/are these 

issues being handled? 

1.14 
Appendix I: Methods 

II 	How is the approach funded? 

11.1 What funding streams are being used? 

11 .2 Who controls which funding streams, both originally and through any centralized 

mechanism if the community has one? 

11.3 How do providers gain access to funding, and to the different funding streams if they 

are not combined? 

11.4 What are the issues and problems for providers in getting appropriate funding, with 

respect to eligibility, willingness (to serve the relevant populations, accept particular 

funding streams, etc.), capability (to write proposals and also to do the work), knowledge 

of funds availability, timing and complexity of application process, etc.? 

11.5 If multiple funding sources are mingled, how did this come about? 

11.6 Do requirements of the funding sources create any barriers or promote any successes? 

11.7 If the current funding reality took a while to develop, how did it happen and what did it 

look like when you started working to end chronic street homelessness (what funding 

was available, from whom, how hard to get, etc.)? 

11.8 How vulnerable are the various funding streams you use to reduction or elimination? 

Are any likely to increase? 

11.9 We all know there is never enough money. 	Where are the gaps and weak points in your 

system? If the community had more money, where would it go, realistically, considering 

politics and community pressures? Would it be used to reduce/end chronic street 

homelessness, or are the priorities elsewhere? If yes, where? 

us 
Appendix I: Methods 

Outreach-Caseworker Discussion Guide 

Use when interviewing outreach workers and caseworkers, as individuals or in groups. 

Introduction 

Introduce yourselves and WRMAIUI, describe study - best practices in ending chronic street 

homelessness, funded by HUD. Pass around project description if people want it. 

Ask people to fill in the sign-up sheet 

Describe how information will be used: 

We will be naming cities and programs 

We will be listing people we interviewed by name and program affiliation at the end of the 

report. 

We will NOT be quoting outreach workers and case workers by name 

We are very glad to have this chance to speak with you, the outreach/caseworkers who have the 

most direct contact with homeless people themselves and do the most to connect them to 

programs and services. We'll also be talking to the directors of the programs you work for, and 

to some of the clients who have gone through the system. But we are particularly interested in 

getting your views on your work, because you have the most down-to-earth experience of how 

easy or hard it is to link people up with the things they need. 

1. 	 Who do you outreach to/who comes to your drop-in program/who do you do case 

management with? 

1.1. (OR/drop-in only) Do you only approach/work with individuals, or do you also interact 

with street homeless in groups, as in encampments? 

1.2. If both, what is similar and what is different about your approach? If not both, why not? 

2. 	 Please describe how you do your work 

2.l. Where? 

2.1.1. On the streets, walking 

2.1.2. From cars or vans 

2.1.3. In shelters or feeding programs 

2.1.4. Do you go to jails, hospitals, or other such settings? 

2.l.5. At their residential program 

2.1.6. In my office or elsewhere that is inside but not where clients live 

2.2 When? What times of day or night? 

1.16 
Appendix I: Methods 

2.3 	 Alone or in teams? If in team, with someone else from your program, or from another 

program? 

2.4 Backup -	 are there people, or services you can call if you run into particular issues or 

problems? Which issues/problems, and where do you call? 

2.5 Sharing information - ever? 

2.5.1 	 If yes, with whom - your teammate, other teams or workers from your own 

agency, workers from any other agency? 

2.5.2 	 If yes, what are the purposes of this information sharing? (e.g., facilitating service 

delivery, not tripping over each other's feet, putting all info into a single system, 

turning one of your "people" over to someone else for a next step in the·system) 

3. 	 What services/connections do you have to offer the people you contact? Food, health care, 

cash benefits, housing, other? 

3.1 . What works to "bring people in" from the streets? 

3.1.1. 	 What do you offer that they want? 

3.1.2. 	 How do you build relationships/trust with the people you work with on the 

street/in this program? 

3.l.3. 	 How long does it take, usually? 

3.1.4. 	 Do you have one or more strategies that seem to work well (e.g., getting them 

tangible benefits while still on the street such as SSI or food stamps; approaching 

them at critical moments such as when they have been arrested, to see if you can get 

them to accept services/housing when they come out, other) 

3.l.S. 	 What is your relationship with police, storekeepers, other members of the public 

on your "beat?" If you act as a go-between in relation to street homeless people, 

about what, how do you do it, give examples? Do they help or hinder your 

outreach/casework efforts? 

4. 	 Is success (convincing someone to come in off the streets) contingent on personal relations, 

having something to offer, what? 

5. 	 How are you able to connect your clients/residents to the other pieces of the system 

including 

5.1. How do your clients connect to services? 

5.2. How do they get housing? How many steps does it take from the streets (e.g., ES, TH, 

the PSH, or directly into housing)? 

5.3. How does your staff interact with other programs/agencies to assure that clients get what 

they need? 

5.4. What are the specific linkages? How, literally, does it work? 

5.5. If relevant, how does your program support formerly street homeless people in housing 

once you get them in it? 

I.l7 
Appendix I: Methods 

6. 	 Please describe what you think of as the typical route, or routes, by which chronic street 

homeless people in this city are able-to leave the streets and achieve stable housing, whether 

supported or not? 

6.1. Where do your own activities fit in? 

7. 	 Thinking about connections, to other homeless services and to mainstream programs and 

agencies, do you think there is a good system in this community for helping chronic street 

homeless people leave homelessness permanently? 

7.1. If yes, 

7.1.1. What are its essential parts? 

7.1.2. How does the system work (how do clients flow through it)? 

7.1.3. What keeps this system going? 

7.2. If no, or not a good one, 

7.2.1. What is missing? 

7.2.2. Where do things break down? 

7.2.3. 	 Or is there just no structure at all for helping chronic street homeless people 

transition out of homelessness? 

U8 
Appendix I: Methods 

Data Issues Discussion Guide 

Can the community document its success in reducing chronic street homelessness? 

1. 	 Does the community do street counts? 

1.1 	 Since when? 

1.2 	 What is the geographic coverage, frequency, who does it, other descriptive 

1.3 	 If yes, get the documentation. 

2. 	 Does an HMIS exist? 

2.1 	 If yes, is it capable of providing data for the last several (at least 2) years? 

2.2 	If yes, have the data been used to measure the effectiveness of the approach? 

2.2.1 	 What do the results show? Get the HMIS evidence of reductions in chronic 

street homelessness? 

2.3 	 If no, what is the status of HMJS development? 

3. 	 Have any state or local evaluations of the community approach to reducing/ending chronic 

street homelessness been conducted? 

3.1 	 What do these studies find with respect to ending chronic street homelessness in your 

city? 

3.2 	If anything available, get the results/documentation. 

4. 	 How does the community use its data, other than to document success? 

4.1 Daily for case management? 

4.2 Weekly or monthly for system feedback about glitches, bottlenecks in service delivery? 

4.3 To identify gaps and plan for additional programs/services? 

4.4 Reports to funders? 

4.5 To lobby for additional funding based on arguments of efficiency and effectiveness? 

4.6 Other? 

5. 	 Collect community documentation of as many of the following as possible with respect to 

people who experienced chronic street homelessness, from whatever sources can provide 

them: 

5.1 	 Decreases in numbers of homeless people who chronically spend nights in places not 

meant for habitation; 

5.2 	Increase in numbers now stably housed in pennanent supportive housing (stable = at 

least 1 year, also look for average length of stay of 12 months or more); 

5.3 	 Increases in numbers in regular affordable housing without supports (also stable, by 

above defrnition); 

1.19 
Appendix I: Methods 

5.4 Increases in numbers receiving appropriate services from mainstream agencies 

(including mental health, substance abuse, cash benefits, health,health insurance, and so 

on), and keeping! maintaining them-for at least I year; 

5.5 	 Increases in numbers employed in jobs that they have held fOr at least 6 months (doesn't 

have to be full time); 

5.6 	Increases in numbers/proportions being discharged from institutions (including 

correctional facilities and VA facilities) with appropriate housing resources and 

maintainiilg them for at least 1 year. 

I.20 
Appendix I: Methods 

Program-Specific Discussion Guide 


Use when interviewing program directors, also subset (marked with **) for caseworkers. 


1. Describe your program's mission or goals related to chronic street homeless people. 

1.1 How long has it been serving chronic street homeless people? 

l.2 Was tills part of the program's original mission? 

1.2.1. 	 If no, how did the mission enlarge to serve tills population? What issues were 

involved? How were they addressed? 

1.2.2. 	 Are these still issues? How is your program addressing them? 

1.3 	 Are there other issues in serving tills population? What are they? How is your program 

addressing them? 

2. 	 If you feel your program uses a particular model(s) of care (e.g., housing fIrst, stages in a 

continuum, clean and sober vs. not, voluntary vs. mandatory service participation), could 

you describe it/them and why you have chosen these approaches? 

3. 	 **How do (formerly) chronic street homeless people get into your program? 

3.1 How easy, regular, routine are these routes to services for chronic street homeless 


people? 


4. 	 If your program does outreachlhas drop-in4.1 To whom, where, etc.? 

4.2. 	 Why? What is the rationale for doing outreachlhaving drop-in? 

4.3 . 	 What services/connections do you have to offer the people you contact? 

4.4. 	 What works to "bring people in?" What do you offer that they want? 

4.5. 	 Is success contingent on personal relations, having sometillng to offer, what? 

5. 	 If your program doesn't do outreach, or not much5.1 Why not? 

5.2. 	 What then serves as the entry point to your program for chronic street homeless people? 

6. 	 **What does your program offer (fonnerly) chronic street homeless people? 

1.21 
Appendix 1: Methods 

6.1 	How does your program move them on to some subsequent stage or directly into 


permanent housing? or 


6.2. 	 How does your program support them in housing once you get them in it? 


6.3. 	 How easy, regular, routine are these routes to services and housing? 


7. 	 **How are housing and services linked in your program? 

7.1 	 Voluntary or mandatory participation in services? 


7.1.1. 	 Right to housing even if do not participate in services? 


7.1.2. 	 If voluntary, please describe the approaches you use to induce people to 


participate in services and supports? 


7.2. 	 How do people taper off of supports, if they do? 


7.2.1. 	 Do they ever go completely independent? 


7.2.2. 	 Can they fluctuate in their use of supports, as needed? 


7.2.3. 	 Begin receiving again once they have become (mostly) independent? 


7.3. 	 How are client funds handled? 


7.3.1. 	 Must clients yield control to a representative payee? 


7.3.2. 	 Is rep payee available but voluntary? 


7.3.3. 	 Other arrangements for handling funds and assuring rent payment? 


8. 	 **How does your program connect (how are you able to connect your clients/residents) 

to the other pieces of the system including 

8.1. 	 How do your clients connect to services? 


8.2. 	 How does your staff interact with other programs/agencies to assure that clients get 


what they need? 


9. 	 **Please describe what you think of as the typical route, or routes, by which chronic 

street homeless people in this city are able to leave the streets and achieve stable housing, 

whether supported or not? 

9.1. 	 Where does your program fit in? 


10. 	 **Thinking about connections, to other homeless services and to mainstream programs and 

agencies, do you think there is a good system in this community for helping chronic street 

homeless people leave homelessness permanently? 

1.22 

Appendix I: Methods 

10.1. If yes, 


10.1.1. What are its essential parts? 


10.1.2. How does the system work (how do clients flow through it)? 


10.1.3. What keeps this system going? 


10.2. If no, or not a good one, 


10.2.1. What is missing? 


10.2.2. Where do things break down? 


10.2.3. Or is there just no structure at all for helping chronic street homeless people 


transition out of home1essness? 


11. How does your program handle relations with its neighbors? 

11. lAs part of early siting and development? 

11.2 At move-in? 


11.3 Now? 


12. How is your program funded? 

12.1 How stable is the funding? 


12.2 How hard is it to put together the funding package you have? How many applications, 


etc? 


12.3 Issues/difficulties with maintaining funding package? Recent (or future) threats to 


funding? 


12.4 What would happen if you lost significant funding? 


13. What data do you collect on your own clients: 

13.1 While they are with the program 


13.2 How you learn about client experiences with other programs 


13.3 How you connect your data with data from other programs or an overall data system 


such as an HMIS 


13.4 How you learn about long-term (1 year +) client outcomes, and for what proportion of 


clients. 


1.23 

Appendix I: Methods 

14. We all know there is never enough money. 

14.1 	Where are the gaps and weak points in the system of programs and services in your 

community to serve (formerly) chronic street homeless adults? 

14.2 If the community had more money, where would you want it to go? 

14.3 Where would it go? Would it be used to reduce/end chronic street homelessness, or are 

the priorities elsewhere? If yes, where? 

1.24 
Appendix E: Philadelphia 

The Housing Support Center is a new program just getting under way within Adult Services. 

When fully operational, it will bring together resDurces from Adult Services, DHS, CBH, the 

County Assistance Office (cash assistance), the Philadelphia Housing Authority (PHA), and 

other public agencies whose clients face challenges to housing stability. It will serve as the city's 

central referral point for all households needing help because they are experiencing homelessness 

or facing homelessness, including families whose involvement with child welfare arises chiefly 

from their lack of housing. 

Supportive Services. Agencies under the Behavioral Health System offer prevention, outreach, 

substance abuse, and mental health services through their own staff and by contracting with 

nonprofit homeless assistance programs. CODAAP and OMH are city offices whose staff 

provide care directly and who also pay for· services and shelterlhousing through contracts for 

people meeting their eligibility criteria. Both work closely with the outreach teams under the 

OCC run by Project H.O.M.E., as well as supporting outreach teams of their own. Direct mental 

health and substance abuse treatment is also supplied through Community Behavioral Health 

(CBH), the city's nonprofit managed behavioral health care entity covering poor people with 

behavioral health disorders, whether Medicaid beneficiaries or not. All are components of 

Philadelphia's BHS. 

Who Is Served? 

Philadelphia has a major focus on reaching and serving men and women experiencing chronic 

street homelessness. Most have one or more disabilities. None is excluded on principle, although 

there are far from enough units to serve all who need them. Programs have been created for 

people with mental illness, co-occurring disorders, fragile HIV / AIDS victims with or without 

other problems, and other special groups. There is even a unit (the Transitional Treatment Unit, 

run by Horizon House) designed specifically for people who have been banned from using 

shelter due to repeated episodes of disruptive behavior exhibited during prior shelter stays, which 

works with residents to help them adopt acceptable behavior. Mainstream mental health and 

substance abuse services have been expanded to address the needs of homeless people with those 

problems, and specialized services have been developed for the large proportion of people who 

do not fit neatly into pre-existing categories because they have two or more co-occurring 

disorders. 

Philadelphia's focus on chronic street homelessness begins with outreach, as indicated by the 

high proportion of organizations in Table E.1 engaged in outreach andlor offering drop-in 

services. First-entry residential services also have developed accommodations for people with a 

variety of disabilities, especially those with low tolerance for the rules or the large nwnbers of 

people crowded together in mass emergency shelters. A variety of damp and wet shelters exist, 

as well as those requiring sobriety. Safe havens have been developed and PDR slots made 

available to homeless people whose mental illness, substance use, or both make them unwilling 

or unable to respond, at least initially, to case plans and goal-setting. Finally, the past two 

decades have seen the development of many varieties of peffi1anent supportive housing able to 

accommodate people with a variety of chronic conditions. 

E.13 
Appendix E: Philadelphia 

Coordination Mechanisms 

Philadelphia has several coordination mechanisms, ranging from those in most immediate 

contact with homeless people to those that concentrate on mainstream agency coordination and 

long-range planning. These include two mechanisms operating at system entry, two that 

coordinate specialized services, two that coordinate the efforts of city agencies, and three that 

focus on planning and system development citywide. Overlapping memberships and an open 

attitude toward developing and maintaining cooperative relationships keep the coordinating 

mechanisms in touch with each other. 

System Entry. Two coordination mechanisms operate at the point of system entry-the Outreach 

Coordination Center run by Project H.O.M.E., and central intake run by OESS. 

The OCC coordinates most of the city's outreach efforts. These include a 24-hour homeless 

hotline, five outreach teams, up-to-date lists of shelter availability, and regular street counts. The 

hotline receives calls from businesses, civic and neighborhood associations, and private citizens 

about homeless Reople in need, and dispatches outreach workers to assist. The five largest 

outreach efforts 1 cover Center City and west and southwest Philadelphia, where the majority of 

chronically homeless individuals who avoid shelters are found. Representatives of all teams meet 

monthly to review activities and needs. Through radio contact with teams, the OCC facilitates 

resolution of the immediate needs of any homeless person in contact with an outreach worker 

that the worker cannot handle independently. OCC workers have conducted street counts of 

homeless people every quarter since 1998. 

Since its inception in 1998, the OCC has maintained a database of all persons contacted by the 

participating outreach teams, averaging about 2,000 unduplicated individuals annually. OCC 

teams repeatedly see about one-fourth of those they contact over a span of years. These are the 

chronic street homeless people the teams try hardest to induce off the streets. Through common 

identifiers, the OCC database can be linked with the OESS database that chronicles most 

emergency shelter and some transitional housing stays. Using this link, OCC workers can see 

whether any of their consumers have used shelter, and how much. Conversely, OESS analysts 

can assess the proportion of people making heavy use of emergency shelter who are also well 

known to outreach workers. 

Recent analyses for a proposal in response to the Federal Chronic Homelessness Initiative NOF A 

(which Philadelphia just won) made just these comparisons, indicating the power of these types 

of tracking databases and what one can learn from them to help shape policy. Analyses of the 

OESS database showed that 2,731 individuals were chronically homeless. Over the four years 

from 1999-2002, 2,404 individuals who are still homeless were chronic users of emergency 

shelter, and street outreach staff repeatedly encountered 572 persons. A match of databases 

indicated that 245 persons qualified in both categories; counting these people only once brought 

the total to 2,731. The disability status of the total sample (2,731) was explored using various 

methods, and it is estimated that approximately 30 percent have a serious mental illness, 

31 The oee coordinates one comprehensive response team, two mental health specialty teams, and two substance 

abuse specialty teams (one peer and one professional). It has a case management component and access to tbe 

OESS list of available shelter beds. 

E.14 
Appendix I: Methods 

Focus Group Discussion Guide 

For Participants of Programs to End Chronic Street Homelessness 

Thank you for meeting with us today. My name is "XXX" and this is "YYY" and we are here as 

part of a study to understand how programs like [name ofprogram/s used to recruit] can help 

people who have been living on the streets for a long time fmd a place to live and stay off the 

streets. You were invited because you have had these experiences. For this study, we are also 

talking with the people who plan, run, and pay for programs like this. We are also visiting other 

communities across the country to understand what they are doing to help people in need. 

We would like to learn about your experiences in "getting off the streets" of [name ofthis 

community] and your ideas about what programs or services are working well and what can be 

done better. There are no "right" or "wrong" answers. We hope you will feel free to share your 

point of view even if it differs from what others have said. Often, we're just as interested in 

comments about difficulties as in comments about successes. At times, learning about 

difficulties is the most helpful. We are really just interested in understanding how well programs 

like those here in [name ofthis community] work from the perspective of people who have 

experiences like yours. 

You've probably noticed the microphone. We're tape recording the session because we don't 

want to miss any of your comments. People often say very helpful things in these discussions 

and we can't write fast enough to get them all down. We will be on a first name basis tonight, 

and we won't use any names in our reports. You may be assured of complete confidentiality. 

Well, let's begin. We've placed name cards on the table in front of you to help us remember each 

other's names. Let's fmd out some more about each other by going around the table. Tell us your 

name and where you live. 

Note to facilitators: 

Pay close attention to the many themes ofinterest in this study and allow the participants to 

raise them before you bring them up explicitly, they include: 

.:. 	 ease offlow between multiple programs; 

.:. 	 availability ofneeded services; 

.:. 	 voluntary versus mandatory nature o/program services, experiences with each; 

.:. 	 appropriateness ofservices/approach for various sub-groups ofchronic homeless; 

.:. 	 preferences for types ofservices connected to housing, and how they are connected (required 

or voluntary); 

.:. 	 etc. ADD HERE... 

1.25 
Appendix 1: Methods 

"Getting Off the Streets" for the First Time 

I'd like to begin our discussion by asking everyone how and when you first came in off the 

streets (not just in for a meal or some time in a drop-in center)? 

Probes to help the discussion along: 

• 	 What made you decide to "come in"? (word on the street, another homeless person, specific 

servIce . provI ·d?) er. ... 

• 	 What program or person first helped you? [we want to know what type ofprogram this is/was 

so try to get exact namels and confirm type/s later} 

• 	 There must have been many times before you decided to "come in" that you thought about it, 

or that people asked if you wanted to "come in." What was different about this time? Were 

you just 'ready?" Did [program/person} offer you something or some service in particular 

that made it okay for you to leave the streets? 

• 	 What did you know about this program/person before you came in? How did you know this? 

• 	 Were the program and the help you received what you expected? Any "surprises"? 

• 	 Did you get everything you needed when you first came in? Was there anything that you 

didn't need/want but had to do? 

• 	 Was there anything that should have been done differently or better? 

• 	 How well would the program or services that helped you "come in" work for other people 

you know who are still living on the streets? What do they need? How could they be helped 

off the streets for the first time? 

"Next Steps" After Getting Off the Streets 

Now I'd like to talk about what happened after you first got offthe streets. Did you return to the 

streets? Did you stay with the first program that helped you off the streets, or did you move onto 

another program or location? 

Probes for those who went back to the streets: 

• 	 Why did you return to the streets? 

• 	 Was it because of something the program did or didn't do? What 

1.26 
Appendix I: Methods 

• 	 Was there anything that could have been done differently to stop you from returning to the 

streets? 

• 	 How many times did you go back to living on the streets before staying off this time? 

• 	 What would work best to stop people who have come off the streets for the fIrst time from 

returning again? 

Probes for those who stayed offthe streets (andfor staying offthis time): 

• 	 How did you move from one program or location to another? 

• 	 Were the program and the help you received what you expected? Any "surprises"? 

• 	 Did you get everything you needed? Was there anything that you didn't need/want but had to 

do? 

• 	 Did you have to wait a long time for anything? If yes, how long, and for what? 

• 	 Was there anything that should have been done differently or better? 

• 	 How would you feel about having someone be a representative payee for you-that is, 

receiving your money every month and paying your rent and other bills, and then giving you 

what is left over? If a program required you to turn your money over to a staff person to 

manage, how would you feel about it? 

• 	 Would what helped you also work for other people you know who are still living on the 

streets? Who would it work for and why? Who would it NOT work for and why? 

Staying Off the Streets 

The last topic I'd like to cover with you is what it takes to keep people who have lived on the 

streets for a long time from ever going back. What types of services and supports are important 

to helping people stay housed for a long time (forever)? What do you need, now that you have 

been off the streets for a while? What will you need in the future? What have your experiences 

been, both good and bad? 

Probes: 

• 	 What do you know about permanent housing programs (like this one?) in this community? 

Do they work? All of them, or only some? If only some, which ones and why those? How 

good are they? Do they provide you with everything you need (or help you get what you 

need from other programs/places)? 

1.27 
Appendix I: Methods 

• 	 What are the most important things that will help you stay off the streets? Is there anything 

offered by permanent housing programs that you don't really need? 

• 	 In thinking about how the community can help formerly homeless people stay housed 

forever, is there anything that [name ofcommunity] should be doing differently or better? 

• 	 What do you think people who are living on the street right now need in order to leave the 

streets and come to programs such as this one? Would this program work for all of them, or 

just some types of people who are now living on the streets? 

Are there any other experiences or ideas you would like to share with us before we end our 

meeting? Does anyone have any questions fOT us? 

Thank you all so much for your time and help. When we are fmished visiting all the places we 

are studying, we will write a report with our fIndings. We hope that other communities will read 

this report and learn about what they can do to help other people like you. What you have shared 

with us today will help these communities as they develop programs like this. Thanks again. 

Distribute payments in envelopes and have them sign receipts for project accounting. 

1.28 
APPENDIXJ:REFERENCES 


Andersen, A., LLP; Center for Mental Health Policy and Services Research, University of 

Pennsylvania; K. E. Sherwood; and TWP Consulting. 2000. Connecticut Supportive Housing 

Demonstration Program: Final Program Evaluation Report, New Haven, CT: Corporation for 

Supportive Housing. 

Boston Foundation. 2002. Boston Indicators Report 2002. Boston, MA: Author. 

Burt, M. K, D. Pollack, A. Sosland, K. S. Mikelson, E. Drapa, K. Greenwalt, and P. Sharkey, 

2002. Evaluation ofContinuums ofCare for Homeless People: Final Report. Prepared for U.S. 

Department of Housing and Urban Development. Washington, D.C.: U.S. Government Printing 

Office. 

Campbell, M. 200l. "Lack of Affordable Housing a Detriment to City," Birmingham Business 

Journal, 30 April. 

City of Boston. 2000. Leading the Way: A Report on Boston's Housing Strategy FY 2001-2003. 

Boston, MA: Author. 

City of Philadelphia. 1996. Five Year Financial Plan: Fiscal Year 1997-Fiscal Year 2001. 

Philadelphia, P A: Author. 

Coalition on Homelessness and Housing in Ohio. 1999. "Homelessness a 'Major Community 

Issue' for Central Ohioans," Breaking Ground, December: 1-6. 

Community Research Partners. 2001. How We are Doing in Central Ohio: Areas ofProgress 

and Areas ofConcern. Columbus, OH: Author. 

Community Shelter Board. 2003. Moving Forward, March 2003, Rebuilding Lives:Breaking the 

Cycle ofHomelessness. Columbus, OH: Author. 

--. 2003. "Executive Summary, Stakeholder's Input to FY 2003 Allocation Recommendations 

and Application Process: Report to the Board of Trustees, January 30, 2003," Columbus, OH.: 

Author. 

--.2002. Preventing Homelessness: Discharge Planning from Corrections Facilities. 

Columbus, OH: Author. 

--. 2001. "Ending Homelessness in Columbus," Briefing for Members of the U.S. House of 

Representatives, Financial Services Committee, and the U.S. Department of Housing and Urban 

Development, November. Columbus, OH: Author. 

--. 1999. Good Neighbor and Shelter Certification: Draftfor Public Comment, 30 November. 

Columbus, OH: Author. 

1.1 
Appendix J: References 

Corporation for Supportive Housing. 2001. California Supportive Housing Resource Guide: FY 

200112002. Oakland, CA: Author. 

Culhane, D. P., E. F. Dejowski, J. Ibanez, E. Needham, and 1. Macchia. 1994. "Public Shelter 

Admission Rates in Philadelphia and New York City: Implications for Sheltered Population 

Counts," Housing Policy Debate, 5(2): 107-163. 

Culhane, D. P. and R. Kuhn. 1998. "Patterns and Determinants of Public Shelter Utilization 

Among Homeless Adults in New York City and Philadelphia" Journal ofPolicy Analysis and 

Management, 17(1): 23-43. 

Culhane, D. P., S. Metraux, and T. Hadley. 2002. "Public Service Reductions Associated with 

Placement of Homeless Persons with Severe Mental Illness in Supportive Housing," Housing 

Policy Debate, 13(1): 107-163. 

Davis, G., G. Johnson, and S.W. Mayberg. 2003. Effectiveness ofIntegrated Services for 

Homeless Adults with Serious Mental Illness: A Report to the Legislature as Required by 

Division 5, Section 5814, ofCalifornia Welfare and Institutions Code. Sacramento, CA: 

California Department of Mental Health. 

--- 2002. Effectiveness ofIntegrated Services for Homeless Adults with Serious Mental 

Illness: A Report to the Legislature as Required by Division 5, Section 5814, ofCalifornia 

Welfare and Institutions Code. Sacramento, CA: California Department ofMental Health. 

Emergency Shelter Commission. 2002. Homelessness in the City ofBoston Winter 2002-2003: 

Annual Census Report. Boston, MA: Author. 

Goldstein, H. 1990. Problem-Oriented Policing. New York, NY: McGraw-Hill. 

Grieff, D., T. Proscio, and C. Wilkins. 2003. Laying a New Foundation: Changing the Systems 

that Create and Sustain Supportive Housing. New York, NY: Corporation for Supportive 

Housing. 

Greater Philadelphia Urban Affairs Coalition, 1998. Our Way Home: A Blueprint to End 

Homelessness in Philadelphia. Philadelphia, PA: Author. 

Hiller, A. and D. Culhane. 2003. Closing the Gap: Housing (un)Affordability in Philadelphia. 

Philadelphia, PA: Cartographic Modeling Laboratory, University ofPennsylvania. 

Hunter, I., A. Sheff, B. Roth, and A. Dinova. 2002. Welcome to ... AB34IAB 2034: 

Comprehensive, Community-based Treatment Services for the Homeless, Forensic Mentally Ill. 

San Fernando Valley, CA: San Fernando Valley Community Mental Health Center, Inc. 

International Downtown Association. 2000. Addressing Homelessness: Successful Downtown 

Partnerships. Washington, D.C.: Author. 

J.2 
Appendix J: References 

Kasprow, W. J., R. Rosenheck, D. DiLella, and L. Cavallaro. 2002. Health Care for Homeless 

Veterans Programs: Fifteenth Annual Report. West Haven, CT: Northeast Program Evaluation 

Center. 

Kessler, K. and J. Wartell. 1996. "Community Law Enforcement: The Success of San Diego's 

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J.3 
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1.4 

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